Novel Technical Factors Affecting Proximal Humerus Fixation Stability. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Laflamme, G-Yves; Moisan, Philippe; Chapleau, Julien; Goulet, Julien; Leduc, Stéphane; Benoit, Benoit; Rouleau, Dominique M.
• Is Part Of: Journal of orthopaedic trauma. Volume 35:Issue 5(2021)
• Publication Date: 2021-05
• Subjects: proximal humerus fracture -- locking plate fixation -- complications; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000001984
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objectives: Intra-articular screw cut-out is a common complication after proximal humerus fracture (PHF) fixation using a locking plate. This study investigates novel technical factors associated with mechanical failures and complications in PHF fixation. Design: A retrospective radiological study. Setting: Level 1 trauma center. Patients/Participants: Clinical and radiological data from consecutive PHF patients treated between January 2007 and December 2013 were reviewed. Intervention: Open reduction and internal fixation with the Synthes Philos locking plate. Main Outcome Measurements: Postoperative radiographs were assessed for quality of initial reduction, humeral head offset, screw length, number and position, restoration of medial calcar support or the presence of calcar screws, and intra-articular screw perforations. Using SliceOMatic software, we validated a method to accurately identify screws of 45 mm or longer on AP radiographs. Follow-up radiographs were reviewed for complications. Results: Among 110 patients included [mean age 60 years, 78 women (71%), follow-up 2.5 years] and the following factors were associated with a worse outcome. (1) Screws >45 mm in proximal rows [Odds Ratio (OR) = 5.3 for screw cut-out); (2) lateral translation of the humeral diaphysis over 6 mm (OR = 2.7 for loss of reduction); (3) lack in medial support by bone contact (OR = 4.9 for screw cut-out); (4) varus reduction increased the risk of complications (OR = 4.3). Conclusion: The importance of reduction and calcar support in PHF fixation is critical. This study highlights some technical factors to which the surgeon must pay attention: avoid varus reduction, maximize medial support, avoid screws longer than 45 mm in the proximal rows, and restore the humeral offset within 6 mm or less. Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content is Available in the Text.