Christian Bahrs1, Luise Kühle2, Gunnar Blumenstock3, Ulrich Stöckle2, Bernd Rolauffs2, Thomas Freude2. 1. Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen, Germany. Electronic address: C.Bahrs@gmx.de. 2. Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen, Germany. 3. Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls Universität, Tübingen, Germany.
Abstract
BACKGROUND: Very little information on medium- to long-term results is available for surgically treated proximal humeral fractures. The aim of this prospective treatment study was to present long-term results after angular stable plate fixation of displaced proximal humeral fractures and to detect which specific patient- and fracture-related parameters affect the clinical outcome. METHODS: We performed a prospective clinical and radiologic evaluation of 77 patients with a displaced proximal humeral fracture (28 Neer 2-part, 38 3-part, and 11 4-part fractures; 28 AO A fractures, 30 AO B fractures, and 19 AO C fractures) treated with angular stable plate fixation after a mean follow-up period of 96 months (range, 74-133 months). We assessed outcomes with the Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores and evaluated specific patient- and fracture-related parameters including complications. RESULTS: The mean Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were 79, 31, and 12 points. Reasons for revisions were implant-related impingement (n = 13), screw perforation (n = 10), infection (n = 4), and secondary fracture displacement (n = 1). There was a significant association between worse score results and occurrence of secondary fracture displacement, screw perforation, residual bone deformities, and a rotator cuff defect at follow-up. CONCLUSIONS: Good medium- to long-term results after angular stable plate fixation of displaced proximal humeral fracture can be expected. A reconstruction within a range of 15° in both anteroposterior and axillary views and <5-mm tuberosity displacement should be the aim of head-preserving surgery to prevent complications, such as secondary fracture displacement and screw perforation, and a less favorable long-term result.
BACKGROUND: Very little information on medium- to long-term results is available for surgically treated proximal humeral fractures. The aim of this prospective treatment study was to present long-term results after angular stable plate fixation of displaced proximal humeral fractures and to detect which specific patient- and fracture-related parameters affect the clinical outcome. METHODS: We performed a prospective clinical and radiologic evaluation of 77 patients with a displaced proximal humeral fracture (28 Neer 2-part, 38 3-part, and 11 4-part fractures; 28 AO A fractures, 30 AO B fractures, and 19 AO C fractures) treated with angular stable plate fixation after a mean follow-up period of 96 months (range, 74-133 months). We assessed outcomes with the Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores and evaluated specific patient- and fracture-related parameters including complications. RESULTS: The mean Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were 79, 31, and 12 points. Reasons for revisions were implant-related impingement (n = 13), screw perforation (n = 10), infection (n = 4), and secondary fracture displacement (n = 1). There was a significant association between worse score results and occurrence of secondary fracture displacement, screw perforation, residual bone deformities, and a rotator cuff defect at follow-up. CONCLUSIONS: Good medium- to long-term results after angular stable plate fixation of displaced proximal humeral fracture can be expected. A reconstruction within a range of 15° in both anteroposterior and axillary views and <5-mm tuberosity displacement should be the aim of head-preserving surgery to prevent complications, such as secondary fracture displacement and screw perforation, and a less favorable long-term result.
Authors: Luiz Fernando Cocco; André Yui Aihara; Carlos Franciozi; Fernando Baldy Dos Reis; Marcus Vinicius Malheiro Luzo Journal: Patient Saf Surg Date: 2020-08-06
Authors: Ronnart N Kruithof; Henk A Formijne Jonkers; Denise J C van der Ven; Ger D J van Olden; Tim K Timmers Journal: J Orthop Traumatol Date: 2017-08-22
Authors: Patrick Ziegler; Luise Kühle; Ulrich Stöckle; Elke Wintermeyer; Laura E Stollhof; Christoph Ihle; Christian Bahrs Journal: BMC Musculoskelet Disord Date: 2019-09-04 Impact factor: 2.362