Outcomes of Dual Plate Fixation without Adjunctive Grafts in Complex Proximal Humerus Fractures.
Academic Article
Overview
abstract
OBJECTIVES: To assess the outcomes of a dual-plating fixation technique for proximal humerus fractures using a lateral locking plate and an additional anterior reduction plate, without the use of adjuvant grafts. METHODS: Design: Retrospective study. SETTING: Tertiary referral hospital. PATIENT SELECTION CRITERIA: Included were adult patients with displaced proximal humerus fractures (OTA/AO 11A-C) who underwent dual plate fixation with a lateral locking plate and supplemental anterior plate, without adjunctive grafts, between 2018 and 2024. OUTCOME MEASURES AND COMPARISONS: Primary outcomes were union rate and reoperations. Additional clinical outcomes including osteoarthritis (OA), avascular necrosis (AVN), head-shaft angle (HSA) and patient reported outcome measures at greater than 6 months post-op consisting of the QuickDASH and numerical rating scale for pain (NRSP), were evaluated. RESULTS: Forty patients were included (26 female, 65%) with an average age of 60.2 years (SD 15.1, range 27-86). There were 35 (87.5%) OTA/AO Type11B and 11C fractures and 5 (12.5%) with 11A fractures. Twenty-eight patients (70.0%) had 4-part fractures, 7 patients (17.5%) had 3-part fractures and 5 patients (12.5%) had a comminuted 2-part surgical neck fractures. Thirteen (32.5%) patients had medial comminution. The average follow-up was 25.8 months (SD 20.4, range 3.2-73.2). All patients achieved union after the index procedure (100%). Three patients (7.5%) required re-operation with RTSA due to AVN, and one had re-operation due to infection (2.5%). 97.5% healed with <10° loss of humeral head-shaft angle. Four patients (10.0%) showed radiologic signs of AVN resulting in articular screw penetration following fracture healing, and six (15.0%) had signs of OA. The average QuickDASH score was 18.3 (SD 16.1, range 0-59.1) and the average NRSP was 1.9 (SD 2.1, range 0-8). CONCLUSIONS: In a cohort of 40 patients with complex proximal humerus fractures (70.0% 4-part, 17.5% 3-part, 32.5% with medial comminution) treated with a lateral locking plate and an additional anterior plate without adjunctive grafts, the union rate was 100%, re-operations related to AVN occurred in three patients (7.5%) and patient reported outcomes were satisfactory at a minimum of 6 months. LEVEL OF EVIDENCE: A level IV therapeutic retrospective cohort study.
