[Proximal humeral fractures with angle-stable plate osteosynthesis--is everything better now?]

Proximal humeral fractures are common in the elderly as distribution peaks in the 6th and 7th decade. Optimal operative strategy regarding complex proximal humeral fractures is still being discussed controversely. Aim of the study was to evaluate implant associated problems of angle-stable implants in comparison to other established osteosynthetic methods.

198 patients with proximal humeral fractures were treated operatively from 2000 to 2004 in our department with a primary angle-stable plate osteosynthesis. 166 patients (98 females and 68 males) were followed up. Retrospectively we characterized the fractures type by using the NEER-classification and assessed the functional results with the CONSTANT-score (CS).

Overall the average score was 73,4+/-20 points (range 22-94 points) compared to the non-affected side (90,8+/-8 points (46-100 points)). Patients with anatomical reduction of the fracture showed significant better results in the CS (p<0,05). Compared with other osteosynthetic methods, the use of angle-stable plate osteosynthesis showed no better functional results in the end. In 10,8% a humeral head necrosis occurred. 36 patients (21,6%) revealed a secondary loss of reduction with dislocation of the locking screws, regardless the angle-stable fixation. In 14 cases operative revision was necessary.

Using angle-stable implants in the operative treatment of complex proximal humeral fractures good results can be achieved in most cases. Nevertheless, in comparison to alternative operative solutions, the results do not show significant better functional outcome. Important for good functional outcome was an exact anatomical reduction as a material independent variable rather than the decision to use more expensive angle-stable implants. Those, who can fulfil such surgical demands, achieve similar results for the patient, even without using angle-stable implants.