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. 2013 Mar 22:14:102.
doi: 10.1186/1471-2474-14-102.

Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?

Woo-Bin Jung  1 , Eun-Sun Moon, Sung-Kyu Kim, David Kovacevic, Myung-Sun Kim
Affiliations

Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?

Woo-Bin Jung et al. BMC Musculoskelet Disord. .

Abstract

Background: 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.

Methods: Sixty-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.

Results: There 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%).

Conclusions: In 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.

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Figures

Figure 1
Figure 1
(A) Initial radiographs of 82 years old male with osteoporosis showed 2 part proximal humerus fracture. (B) Immediate postoperative radiographs showed fracture fixation in good alignment but medial support was not achieved. (C) At 4 months after operation, the reduction loss without screw perforation was developed. So, the clinical result was failure.
Figure 2
Figure 2
(A) Initial radiograph of 82 years old female with osteoporosis showed 3 part proximal humerus fracture. (B) Immediate postoperative radiograph showed good alignment and successful medial support was achieved by oblique long locking screw. (C) At 12 months follow up, radiograph showed complete bone union and good alignment and the clinical result was excellent.
See this image and copyright information in PMC

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