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Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled
Reinhard A Meier1, Peter Messmer, Pietro Regazzoni
1Trauma Unit, Department of Surgery, Basel University. reinhard.meier@handchirurg.org
Objectives:
The increasing number of fractures of the proximal humerus, especially in the elderly, carries with it the unsolved problem of the optimal treatment for the displaced or unstable fractures. The authors' goal was to analyze whether fixation with a bent valgus angled blade plate could improve the outcomes reported in the literature to date.
Design:
Prospective clinical study.
Setting:
Urban level 1 university trauma center.
Patients:
Over a 27-month period, 42 consecutive patients were treated for an unstable or displaced proximal humerus fracture.
Intervention:
Open reduction and internal fixation with a 90-degree cannulated angled blade plate prebent to 110 degrees.
Main Outcome Measurements:
Active follow-up for 1 year with assessment of objective and subjective functional results (ie, motion; strength; Constant score; Disabilities of the Arm, Shoulder, and Hand (DASH) score; and visual analog scale (VAS)) and radiographic assessment (reduction, alignment, necrosis, and nonunion).
Results:
Follow-up was completed for 86% of the patients, who achieved a mean Constant score of 66 points (82% of the contralateral side) with a mean forward flexion of 125 degrees and an average strength of 72% of the contralateral side. Low disability (mean DASH score 22) and pain values (mean VAS 2) were demonstrated after this type of stabilization. The overall complication rate was 33% (12/36), with protrusion of the blade into the glenohumeral articulation as the most frequent problem (8/36, 22%). The negative impact of an adverse event on subjective and objective outcomes was only significant for forward flexion (P = 0.02). Neither clinical outcome nor complication rate was different when compared to patients with regard to fracture type (3 versus 4 parts) or age (younger or older than 70 years).
Conclusions:
Fixation of displaced proximal humeral fractures with an angled blade plate provided sufficient stability. Blade perforation into the humeral joint occurred in every fourth patient and was found to be the major reason for a high complication rate. In view of this major problem, the technique described here cannot be recommended, even though the absence of nonunions in our series seems to support the low invasiveness of this surgical approach.
