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. 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 included osteoarthritis, avascular necrosis (AVN), head-shaft angle, and patient-reported outcome measures assessed at a minimum of six months postoperatively, consisting of the QuickDASH and the numerical rating scale for pain (NRSP). 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 type 11B 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 reoperation with reverse total shoulder arthroplasty because of AVN, and 1 had reoperation because of infection (2.5%). In total, 97.5% healed with <10 degrees loss of humeral head-shaft angle. Four patients (10.0%) showed radiologic signs of AVN resulting in articular screw penetration after fracture healing, and 6 (15.0%) had signs of osteoarthritis. The average QuickDASH score was 18.3 (SD 16.1, range 0-59.1) and the average numerical rating scale for pain 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%, reoperations related to AVN occurred in 3 patients (7.5%), and patient-reported outcomes were satisfactory at a minimum of 6 months. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
