Plate fixation of the proximal humerus: an international multicentre comparative study of postoperative complications
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 conutry X. Level of evidence: IV.
|Keywords||Locking plate: complications, PHILOS, Predictive factors, Proximal humeral fractures, Re-operations, Screw perforation|
|Persistent URL||dx.doi.org/10.1007/s00402-017-2790-z, hdl.handle.net/1765/102067|
|Journal||Archives of Orthopaedic and Trauma Surgery|
Beeres, F.J.P. (Frank J. P.), Hallensleben, N.D.L, Rhemrev, S, Goslings, J.C, Oehme, F. (F.), Meylaerts, S.A.G, … Schep, N.W.L. (2017). Plate fixation of the proximal humerus: an international multicentre comparative study of postoperative complications. Archives of Orthopaedic and Trauma Surgery, 1–8. doi:10.1007/s00402-017-2790-z