The Impact of Reduction on Survivorship and Outcomes Following Locked Plate Fixation of Proximal Humerus Fractures.

OBJECTIVES

To evaluate outcomes of proximal humerus fractures (PHFs) treated with locked plating constructs and assess association between fracture reduction and outcome.

DESIGN

Retrospective cohort study.

SETTING

Academic tertiary care hospital and affiliated level 1 Trauma Center.

PATIENT SELECTION CRITERIA: All patients treated with proximal humerus locked plating for PHFs (OTA/AO 11A/B/C) by 3 fellowship-trained orthopaedic traumatologists from 2008 to 2020 were screened. Patients were excluded for <12-month follow-up, lack of preoperative radiographic imaging, segmental fracture, isolated tuberosity fracture, humeral nailing, and revision surgery as initial procedure at the study institution.

OUTCOME MEASUREMENTS AND COMPARISONS: Fracture pattern, reduction, fixation characteristics, and failure were radiographically evaluated. Functional outcomes were assessed using range of motion, American Shoulder and Elbow Surgeons score, QuickDASH, Constant score, and SF-12. Survivorship was calculated using the Kaplan-Meier method. Association of variables with failure was assessed.

RESULTS

Among 153 patients treated for PHFs with proximal humerus locked plating, there were 23 OTA/AO A-type, 40 B-type, and 90 C-type fractures. Mean follow-up was 66 months, and mean age 59 ± 15 years (68% female). Mean postoperative coronal alignment was 135 degrees, 91% were fixed within 120-150 degrees, and 53% within 130-140 degrees. Sagittal reduction was neutral in 94%. Medial column restoration was achieved in 80%. Survivorship free from revision surgery was 89% at 5 years. Reduction with coronal alignment outside all neutral reduction ranges (120-150 degrees, 125-145 degrees, 130-140 degrees) and sagittal alignment outside neutral were associated with both radiographic failure and revision surgery ( P < 0.05). Preoperative factors associated with failure included female sex, number of fragments, head-split, fracture-dislocation, valgus coronal alignment, and medial calcar displacement ( P < 0.05). Functional outcomes included overall mean American Shoulder and Elbow Surgeons score of 81 ± 21, QuickDASH 16 ± 19, Constant 80 ± 18, SF-12 Physical 50 ± 9, SF-12 Mental 53 ± 8, active forward flexion 145 ± 33 degrees, active abduction 140 ± 35 degrees, active external rotation 73 ± 24 degrees.

CONCLUSIONS

Proximal humerus locked plating demonstrated a survivorship free from revision surgery of 89% free at 5 years and favorable functional outcomes including mean Constant scores of 80. Fracture reduction was associated with outcome. Reduction with coronal and sagittal alignment outside of neutral were associated with radiographic failure and revision surgery. These findings highlight that favorable functional outcomes can be achieved with restoration of the proximal humerus anatomy.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.