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Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate

Results of a Prospective, Multicenter, Observational Study

¹ Department of Orthopaedic and Trauma Surgery, Albert-Ludwigs-University Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. E-mail address for G. Konrad: gerhard.konrad{at}uniklinik-freiburg.de
² Department of Trauma and Reconstructive Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
³ Orthopaedic and Trauma Surgery, Friederikenstift Hannover, Humboldtstrasse 5, 30169 Hannover, Germany
⁴ Orthopaedic and Trauma Surgery, General Hospital Celle, Siemensplatz 4, 29223 Celle, Germany
⁵ Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Schumannstrasse 20, 10117 Berlin, Germany
⁶ Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital affiliated to Shanghai JiaoTong University, 600 YiShan Road, Shanghai 200233, PR China
⁷ Trauma Surgery Hospital Graz, Göstingerstrasse 24, A-8021, Graz, Austria
⁸ Trauma Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 Groningen, The Netherlands

Investigation performed at the Department of Orthopaedic and Trauma Surgery, Albert-Ludwigs-University Freiburg, Freiburg, Germany

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the AO Foundation, Davos, Switzerland. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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Methods: One hundred and eighty-seven patients (mean age, 62.9 ± 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six-month, and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up.

Results: Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 ± 13.7 points, corresponding to 85.1% ± 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 ± 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture.

Conclusions: Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the present study can lead to a good functional outcome provided that the correct surgical technique is used. Because many of the complications were related to incorrect surgical technique, it behooves the treating surgeon to perform the operation correctly to avoid iatrogenic errors.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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