Medial support is the critical risk factor for preventing failure after plating of proximal humerus fractures
Necmettin Turgut , Mehmet Ekinci
The purpose of this study was to evaluate the risk factors of failure of fixation after locked plating of proximal humerus fractures. The study included displaced 71 proximal humerus fracture operation cases at a single centre between January 2016 and June 2020. All humeral fixation surgeries were performed with a proximal humerus locked plate. The primary outcome measure was failure of fixation. Age, gender, mechanism of injury, operated side, type of fracture, type of anesthesia, ASA score, surgical approach, presence of medial cortical support, neck-shaft angle, medial metaphyseal extension of fracture, medial hinge displacement, number of humeral head screws, number of calcar screws were the assessed variables. Newly proposed risk factors including lateral humeral offset (LHO), lateral glenohumeral offset (LGHO), humeral head diameter (HHD), LGHO/HHD ratio were also assessed radiologically. This study showed that lack of medial support was the only significant factor for the failure of proximal humerus fracture osteosynthesis (p <0.001). Failure of surgery was determined in 14 out of 37 cases who had lack of medial support. Proximal humerus fractures should be anatomically reduced, especially surgeons should obtain the medial support in order to decrease the probability of loss of fixation after surgery.
Key words: Proximal humerus fracture, locked compression plating, medial support, Neer classification