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Complications of the locking plate for displaced proximal humeral fractures
Yi Lu1, Man-yi Wang, Yi-ming Zhu
1Shoulder and Elbow Service, Department of Sports Medicine, Jishuitan Hospital, 4th Clinical Hospital of Peking University, Beijing 100035, China.
Insights
Locking plate fixation for proximal humeral fractures has an 18.5% complication rate, impacting external rotation and functional scores. Careful patient selection and surgical technique are crucial for successful outcomes in treating these fractures.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Biomedical Engineering
Background:
- Locking plates are increasingly used for displaced proximal humeral fractures.
- Complications associated with locking plate fixation are often underestimated.
- This study evaluates factors influencing complications and compares outcomes in patients with and without complications.
Purpose of the Study:
- To assess the complication rate of locking plate fixation for proximal humeral fractures.
- To identify factors associated with complications after this procedure.
- To compare functional outcomes between patients with and without complications.
Main Methods:
- A cohort of 92 patients with displaced proximal humeral fractures treated with locking plates were followed for an average of 15.2 months.
- Functional outcomes were evaluated using range of motion, Visual Analog Score (VAS), ASES, Constant-Murley, UCLA, and SST scores.
- Complication and non-complication groups were compared based on these functional outcome measures.
Main Results:
- The overall complication rate was 18.5% (17 out of 92 patients).
- Patients with complications exhibited significantly reduced external rotation and lower Constant-Murley and UCLA functional scores compared to those without complications.
- No significant differences in complication rates were observed based on age, sex, injury side, fracture timing, or presence of other injuries.
Conclusions:
- Indication control and meticulous surgical technique are paramount for successful locking plate fixation of proximal humeral fractures.
- Awareness of potential complications and their impact on functional outcomes is essential for orthopedic surgeons.
- Optimizing surgical strategy can mitigate risks and improve patient results.
Background:
Although the locking plate has become popular for treating displaced proximal humeral fractures in recent years, the complications of this method are still underestimated. We tried to evaluate the factors that have an influence on the complications experienced after proximal humeral fractures fixed by locking plates and compare the results from patients having complications with those having no complications.
Methods:
From September 2004 to September 2007, 92 out of 111 displaced proximal humeral fractures treated by open reduction and internal fixation with a locking plate were available for follow-up, with an average time of 15.2 months (12 - 36 months). The range of motion, Visual Analog Score (VAS) for pain, American Shoulder and Elbow Surgeons' Form (ASES), Constant-Murley, University of California-Los Angles scoring system (UCLA) score, and Simple Shoulder Test (SST) for function evaluation was all recorded at the latest follow-up. The results from patients with complications were evaluated according to the indices listed above and compared with those patients without any complications.
Results:
There were 17 patients with complications, an 18.5% complication rate. Among them, the forward flexion, external rotation and internal rotation were 139.1° ± 24.3°, 24.1° ± 19.6°, and up to T10 level on average. The mean VAS score was 1.0 ± 1.1, the ASES score was 82.9 ± 13.8, the Constant 82.1 ± 11.8, the UCLA 28.5 ± 4.1 and the mean SST 9.5 on average. There was no significant difference of complication rate among different age, sex, and injured side, fresh or delayed fracture, combined with other injury or not groups. Compared with the group without complications, patients with complications showed significantly less external rotation and lower Constant-Murley and UCLA functional scores (P < 0.05). A significant difference in results was seen between patients with complications and those without complications.
Conclusion:
The indication control and appropriate surgical technique were important while performing the locking plate fixation for proximal humeral fractures.
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