Frank J P Beeres1, N D L Hallensleben2, S J Rhemrev3, J C Goslings2, F Oehme4, S A G Meylaerts3, R Babst4, N W L Schep5. 1. Klinik Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Lucerne, Switzerland. frank.beeres@luks.ch. 2. Trauma Unit, Department of Surgery, Amsterdam Medical Centre, Amsterdam, The Netherlands. 3. Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands. 4. Klinik Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Spitalstrasse, 6000, Lucerne, Switzerland. 5. Department of Surgery, Maasstad Medical Centre, Rotterdam, The Netherlands.
Abstract
OBJECTIVE: The primary aim was to evaluate the number of complications following locking plate fixation of proximal humeral fractures in country X and in country Y. The secondary aim was to identify risk factors for complications. METHODS: Multicentre retrospective case series of 282 consecutive patients with proximal humeral fractures, treated with a locking plate between 2010 and 2014. SETTING: two level 1 trauma centres in country X and one in country Y. Data pertaining to demographics, postoperative complications and re-operations were collected. Fractures were classified according to the AO and Hertel classifications and experienced surgeons assessed the quality of reduction and plate fixation on the postoperative X-rays. Outcomes of the two different countries were compared and logistic regression analysis was performed to analyse the relationship between risk factors and complications. RESULTS: During a median follow-up of 370 days, 196 complications were encountered in 127 patients (45%). The most frequent complications were: screw perforation in the glenohumeral joint (23%), persistent shoulder complaints (16%), avascular necrosis of the humeral head (10%) and secondary fracture displacement (5%). In 80 patients (28%), 132 re-operations were performed. The patients operated in country X had significantly more complications compared with the patients operated in country Y. For implant-related complications, advanced age, non-anatomic reduction of the greater tuberosity, and country of operation were risk factors. CONCLUSION: The use of locking plates for proximal humeral fractures was associated with a high number of complications in both countries; the patients operated in country Y, however, had better results compared with the patients operated in country X. LEVEL OF EVIDENCE: IV.
OBJECTIVE: The primary aim was to evaluate the number of complications following locking plate fixation of proximal humeral fractures in country X and in country Y. The secondary aim was to identify risk factors for complications. METHODS: Multicentre retrospective case series of 282 consecutive patients with proximal humeral fractures, treated with a locking plate between 2010 and 2014. SETTING: two level 1 trauma centres in country X and one in country Y. Data pertaining to demographics, postoperative complications and re-operations were collected. Fractures were classified according to the AO and Hertel classifications and experienced surgeons assessed the quality of reduction and plate fixation on the postoperative X-rays. Outcomes of the two different countries were compared and logistic regression analysis was performed to analyse the relationship between risk factors and complications. RESULTS: During a median follow-up of 370 days, 196 complications were encountered in 127 patients (45%). The most frequent complications were: screw perforation in the glenohumeral joint (23%), persistent shoulder complaints (16%), avascular necrosis of the humeral head (10%) and secondary fracture displacement (5%). In 80 patients (28%), 132 re-operations were performed. The patients operated in country X had significantly more complications compared with the patients operated in country Y. For implant-related complications, advanced age, non-anatomic reduction of the greater tuberosity, and country of operation were risk factors. CONCLUSION: The use of locking plates for proximal humeral fractures was associated with a high number of complications in both countries; the patients operated in country Y, however, had better results compared with the patients operated in country X. LEVEL OF EVIDENCE: IV.
Authors: Ruben J Hoepelman; Yassine Ochen; Frank J P Beeres; Herman Frima; Christoph Sommer; Christian Michelitsch; Reto Babst; Isabelle R Buenter; Detlef van der Velde; Egerbert-Jan M M Verleisdonk; Rolf H H Groenwold; Roderick M Houwert; Mark van Heijl Journal: PLoS One Date: 2022-02-25 Impact factor: 3.240