Patient satisfaction after removal of locking plates in proximal humeral fractures – Worth the surgery under functional and cosmetic aspects?

Abstract

BackgroundLocking plates are one of the most frequently used implants in surgical treatment of displaced proximal humeral fractures. In spite of this established implant and standardized approach, reduced shoulder function might remain a mid- to long-term issue, furthermore scars may influence patient satisfaction as a cosmetic issue. Indications for a second surgery to remove implant and/or scar revision are common questions in this context.Aim of the present study was to assess the benefit of a second surgery including implant removal and scar revision surgery on patients’ satisfaction under functional and cosmetic aspects. MethodsPatients following displaced proximal humeral fractures treated by open reduction and internal fixation with a locking plate osteosynthesis via a delto-pectoral approach and following implant removal were included retrospectively. Follow-up took place anamnestically before the incident or the primary surgery [A], before second surgery [B] and after second surgery (Scar revision/implant removal) [C]. Functional outcome (Constant Score (CS)) of both shoulders was obtained using a PROM to evaluate the contralateral side as well as percentage CS (%CS). Furthermore, cosmetic outcome was evaluated for color, contour and size. ResultsClinical data of n=81 patients with displaced proximal humeral fractures and consecutive open reduction and internal fixation (=ORIF) with a locking plate (51 women ≙ 63,0% and 30 men ≙ 37,0%; mean age: 53.7 ± 16.6 years) via a standardized deltopectoral approach could be included. The mean Constant Score (CS) before sustaining the humeral fracture/primary surgery [A] was anamnestically 85.8 ± 8.5 points and %CS 99.4 ± 8.4%. After ORIF with a locking plate osteosynthesis [B] the mean CS was 72.2 ± 9.1 points and %CS 84.5 ± 8.7%. Following scheduled implant removal and scar revision [C] the CS was 80 ± 13.1 points and %CS 92.3 ± 14.1%.After primary surgery 26 patients (32.1%) complained about the scar because of color, contour or size before second surgery and 23 patients (28.4%) afterwards. ConclusionImplant removal after locking plate osteosynthesis in proximal humeral fractures via a delto-pectoral approach leads to an improved outcome both functionally and cosmetically. Constant score as well as scar situation and patients’ overall satisfaction could be improved with a secondary surgery. Nevertheless, need for secondary surgery depends on the patients’ functional and cosmetical demand.