Outcomes of Dual Plate Fixation Without Adjunctive Grafts in Complex Proximal Humerus Fractures

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Biomedical engineering

Background:

• Proximal humerus fractures are common, particularly in older adults.
• Complex fractures often require surgical intervention to restore function.
• Dual plating offers a potential solution for challenging fracture patterns.

Purpose of the Study:

• To evaluate the efficacy of a dual-plating technique for proximal humerus fractures.
• To assess union rates, reoperation rates, and clinical outcomes.
• To determine the effectiveness of this technique without adjuvant grafts.

Main Methods:

• Retrospective cohort study of 40 adult patients with displaced proximal humerus fractures (OTA/AO 11A-C).
• Dual plate fixation using a lateral locking plate and an anterior reduction plate.
• Outcomes assessed included union, reoperations, osteoarthritis, avascular necrosis (AVN), head-shaft angle (HSA), QuickDASH, and numerical rating scale for pain (NRSP).

Main Results:

• 100% union rate achieved after the index procedure.
• Three patients (7.5%) required reoperation for AVN, and one (2.5%) for infection.
• 97.5% healed with minimal loss of head-shaft angle (<10°).
• 10% showed signs of AVN, and 15% developed osteoarthritis.

Conclusions:

• Dual plating with a lateral locking plate and anterior plate is effective for complex proximal humerus fractures.
• The technique demonstrates a high union rate and satisfactory patient-reported outcomes.
• While AVN is a potential complication, overall results are promising without grafts.