Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes
Philipp A Michel1, Michael J Raschke1, J Christoph Katthagen1
1Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany.
Insights
Double plating offers good stability for complex proximal humeral fractures (PHF). This study found favorable radiological and functional outcomes, with a complication rate comparable to existing literature, making it a viable option for younger patients.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Biomedical Engineering
Background:
- Proximal humeral fractures (PHF) pose treatment challenges, with limited data on double plating techniques.
- Assessing the clinical and radiological outcomes of double plating for PHF is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate the clinical and radiological outcomes and complication rates of double plating in patients with proximal humeral fractures.
- To determine the effectiveness of double plating as a treatment option for complex PHF.
Main Methods:
- Retrospective study of 35 patients with unilateral PHF treated with double plating between 2013 and 2019.
- Radiological assessment of neck shaft angle (NSA) and clinical assessment using Constant-score, Simple Shoulder Test (SST), and Subjective Shoulder Value (SSV).
- Follow-up periods: radiological (21 ± 16.6 months) and clinical (29.5 ± 15.3 months).
Main Results:
- No significant difference in NSA between intraoperative and follow-up measurements (p = 0.267).
- Good functional outcomes: Constant-score (78.5 ± 17), SST (9.3 ± 3.2), SSV (78.8 ± 19.5%).
- Overall complication rate was 31.4% (14.3% excluding stiffness); avascular necrosis occurred in 5.7%.
Conclusions:
- Double plating demonstrates good radiological and functional outcomes for complex proximal humeral fractures.
- The complication rate is comparable to existing literature, suggesting it's a viable alternative to fracture arthroplasty, particularly for younger patients.
Abstract:
Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. The mean age was 59.5 ± 12 years and the leading fracture type was a varus dislocation (Resch type IV in 55.3%). A head-split was present in 22.9% of the cases. The primary outcome measurement was the radiological neck shaft angle (NSA). The radiological follow-up was 21 ± 16.6 months and the NSA did not differ between the intraoperative and follow-up time point (131.5 ± 6.9° vs. 136.6 ± 13.7°; p = 0.267). The clinical follow-up was 29.5 ± 15.3 months. The Constant-score was 78.5 ± 17 points, the simple-shoulder-test (SST) was 9.3 ± 3.2 points and the subjective shoulder value (SSV) was 78.8 ± 19.5%. The over-all complication rate was 31.4%, and without stiffness 14.3%. An avascular necrosis occurred in two patients (5.7%). In conclusion, this study shows good radiological and functional outcomes after double plating of highly complex proximal humeral fractures, while the complication rate is comparable to the literature. Double plating is a viable option especially for younger patients with complex fractures as a potential alternative to fracture arthroplasty.
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