The use of locked plates in repairing osteopenic 3- and 4-part proximal humerus fractures remains controversial. The purpose of this article was to report the outcomes of open reduction and internal fixation in low-energy proximal humerus fractures treated with locked plating in patients older than 55 years and stratify risk of failure or complication based on initial radiographic features.
Design: Retrospective.
Setting: Level I Trauma Center.
Neer 3- and 4-part proximal humeral fractures in older patients with initial varus angulation of the humeral head had a significantly worse clinical outcome and higher complication rate than similar fracture patterns with initial valgus angulation. Two factors had significant influence on final outcome in these fracture patterns: initial direction of the humeral head angulation and length of the intact metaphyseal segment attached to the articular fragment. The best clinical outcomes were obtained in valgus impacted fractures with a metaphyseal segment length of greater than 2 mm, and this was independent of Neer fracture type. Humeral head angulation had the greatest effect on final outcomes (P < 0.001), whereas metaphyseal segment length of less than 2 mm was predictive of developing avascular necrosis (P < 0.001).
Copyright remains with the authors and publisher.
The use of locked plates in repairing osteopenic 3- and 4-part proximal humerus fractures remains controversial. The purpose of this article was to report the outcomes of open reduction and internal fixation in low-energy proximal humerus fractures treated with locked plating in patients older than 55 years and stratify risk of failure or complication based on initial radiographic features.
Design: Retrospective.
Setting: Level I Trauma Center.
Neer 3- and 4-part proximal humeral fractures in older patients with initial varus angulation of the humeral head had a significantly worse clinical outcome and higher complication rate than similar fracture patterns with initial valgus angulation. Two factors had significant influence on final outcome in these fracture patterns: initial direction of the humeral head angulation and length of the intact metaphyseal segment attached to the articular fragment. The best clinical outcomes were obtained in valgus impacted fractures with a metaphyseal segment length of greater than 2 mm, and this was independent of Neer fracture type. Humeral head angulation had the greatest effect on final outcomes (P < 0.001), whereas metaphyseal segment length of less than 2 mm was predictive of developing avascular necrosis (P < 0.001).
Copyright remains with the authors and publisher.