Abstract
BackgroundThe purpose of this study was to evaluate the role of medial support and clinical factors responsible on outcomes and major complications associated with treatment of unstable proximal humerus fractures using a locking plate and suture augmentation.MethodsSixty-three cases in 62 patients (42 female, 20 male) were evaluated between September 2004 and October 2008. Cases were divided into either a medial support group (36 cases) or non-medial support group (27 cases). Clinical and radiographic evaluations included Neer’s evaluation criteria, the neck-shaft angle using the Paavolainen method, and complications. We analyzed the correlation between bone- and fracture- related complications and three independent clinical variables, such as the presence of medial support, fracture type, and osteoporosis by way of multivariate logistic regression.ResultsThere were statistically significant differences in the overall incidence of complications based on the presence of medial support (p = 0.014) and preoperative fracture type (p = 0.018), but no differences based on the presence of osteoporosis (p = 0.157). According to multivariate logistic regression analysis, the restoration of medial support was the most reliable factor to prevent bone- and fracture- related complications. In addition, when we compared the incidence of bone- and fracture-related complications in the presence or absence of medial support among 30 patients with osteoporosis, the group with restoration of medial support had only one complication of humeral head osteonecrosis despite the presence of osteoporosis (5.9% vs. 46.2%, p = 0.025). According to Neer’s criteria, excellent or satisfactory clinical results accounted for seventy-three percent of the total cases (46 of 63 cases). Seventy-eight percent (49 of 55 cases) showed good radiographic results by the Paavolainen method. There were 14 complications in 13 of 63 cases (20.6%).ConclusionsIn the treatment of unstable proximal humerus fractures with locking plate technology and suture augmentation, we suggest that obtaining medial support is an important factor in preventing major bone- and fracture-related postoperative complications such as reduction loss or nonunion.
Highlights
The purpose of this study was to evaluate the role of medial support and clinical factors responsible on outcomes and major complications associated with treatment of unstable proximal humerus fractures using a locking plate and suture augmentation
Sociodemographic and clinical characteristics There were 42 women and 20 men who underwent operative treatment of a proximal humerus fracture with locking plate technology and suture augmentation
We found that only one factor, namely the presence of medial support, was responsible for predicting major bone- and fracture-related complications in the treatment of proximal humerus fractures using a locking plate and suture augmentation
Summary
The purpose of this study was to evaluate the role of medial support and clinical factors responsible on outcomes and major complications associated with treatment of unstable proximal humerus fractures using a locking plate and suture augmentation. It is believed that these locking plates provide improved fixation of proximal humerus fractures than the conventional plates, especially for bones that are osteoporotic Despite these advantages, it has been reported that locking plate technology for the surgical treatment of proximal humerus fractures has a high complication rate ranging from 16% to 36% [6,7,8,9,10,11,12,13]. It has been reported that locking plate technology for the surgical treatment of proximal humerus fractures has a high complication rate ranging from 16% to 36% [6,7,8,9,10,11,12,13] Several major complications, such as reduction loss with or without screw perforation, nonunion, humeral head osteonecrosis, and metal breakage, may adversely affect clinical outcome
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