Open Reduction with Internal Fixation of Proximal Humeral Fractures with Plates: Results of 20 Operated Patients

Introduction: This study evaluates the functional and radiological results of surgical treatment with plate and screws of proximal humeral fractures focusing on short and long-term complications.
Materials and Methods: This retrospective study was conducted at Hotel Dieu de France Hospital in Beirut. Inclusion criteria were: (1) Age >18 years old and (2) proximal humeral fracture operated on with the use of a plate (DCP (Dynamic compression plate) or LCP (Locking compression plate). Only 45 patients met these criteria since more than 70% of patients operated on were treated by other methods or dead. 20 patients presented to last follow up. Data collection included: Fracture type (using 2 classification: Codman/Neer and Hertel), early complications (infection, implant failure, stress riser fracture…), functional evaluation of the patient (using the “simple shoulder test”), and late complications (necrosis of the humeral head (NHH), malunion, osteoarthritis…) evaluated on x-rays by 2 independent physicians.
Results: Analysis of the 20 patients revealed 9 males and 11 females; with the mean age of 68 years and a mean follow up of 45 months. The most frequent type (60%) was a three-part fracture involving the great tuberosity. A standard 3,5 plate was used in 6 patients and a proximal humeral locking plate in 14, through a deltopectoral approach. There was neither early superficial nor deep infection. No vascular or neurological complications were noted. Mean SST score was 9.95. No differences between DCP and LCP fixation was noted (P=.27). Fixing tuberosities was not correlated with the SST (Simple Shoulder Test) score (P=.73). Latest x-ray evaluation showed 4 NHH. No correlation was found between functional outcome and the development of NHH (P=.18). Malunion was found in 6 patients (3 varus, 3 valgus). Perforation of the articular surface from long screws was noted in 3 patients. Intraarticular screw had no effect on functional outcome (P=.3).
Conclusion: With a careful preoperative patient’s selection and a good surgical technique, ORIF with both conventional and locking plates gives satisfactory functional results. AVN of the humeral head, when present, does not affect the shoulder’s function.