Factors that Influence Reduction Loss in Proximal Humerus Fracture Surgery
- 1 June 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Orthopaedic Trauma
- Vol. 29 (6), 276-282
- https://doi.org/10.1097/bot.0000000000000252
Abstract
Objectives: This study was performed to identify the risk factors for reduction loss after locking plate fixation of proximal humerus fractures. Design: Retrospective study. Setting: University trauma center. Patients and Intervention: We retrospectively evaluated 252 patients who had been surgically treated for proximal humeral fractures with locking plates between January 2004 and December 2011. Main Outcome Measurements: Charts and standardized x-rays (true anteroposterior and axillary lateral views) were used to evaluate the Neer and AO OTA fracture types, initial neck-shaft angle (NSA, varus displacement), medial comminution, postoperative NSA (reduction adequacy), medial support restoration, healing progress, reduction loss, and implant-related problems immediately after surgery and at 2 weeks, 1 month, 3 months, 6 months, 9 months, and at least 1 year after surgery. Reduction loss was defined as (1) ≥10 of angulation in any direction, (2) ≥5 mm of height loss of the humeral head from the plate, and (3) fixation failure. Results: Reduction loss occurred in 6.7% (17 of 252) of cases; revision surgeries were performed in all cases. Univariable logistic regression analysis revealed that older age (P = 0.023), osteoporosis (P = 0.001), varus displacement (P = 0.001), medial comminution (P = 0.001), reduction adequacy (P = 0.036), and insufficient medial support (P = 0.001) had significant correlations with reduction loss. Conclusions: Multivariable regression analysis revealed that osteoporosis (less than −2.5 bone mineral density, P = 0.015), displaced varus fracture (less than 110° of NSA, P = 0.025), medial comminution (more than 1 fragment, P = 0.018), and insufficient medial support (no cortical or screw support, P = 0.001) were independent risk factors for reduction loss in the proximal humerus fractures surgery. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.Keywords
This publication has 23 references indexed in Scilit:
- Modification of the Resch procedureThe Journal of Bone and Joint Surgery. British volume, 2012
- Angular-Stable Locked Intramedullary Nailing of Two-Part Surgical Neck Fractures of the Proximal Part of the HumerusJournal of Bone and Joint Surgery, 2011
- A systematic review of locking plate fixation of proximal humerus fracturesInjury, 2011
- Clinical Results for Minimally Invasive Locked Plating of Proximal Humerus FracturesJournal of Orthopaedic Trauma, 2010
- Treatment of proximal humerus fractures with locking plates: A systematic reviewJournal of Shoulder and Elbow Surgery, 2009
- Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patientsThe Journal of Bone and Joint Surgery. British volume, 2008
- Proximal humeral fractures: what is semi-rigid? Biomechanical properties of semi-rigid implants, a biomechanical cadaver based evaluationArchives of orthopaedic and trauma surgery, 2007
- Analysis of Efficacy and Failure in Proximal Humerus Fractures Treated With Locking PlatesJournal of Orthopaedic Trauma, 2007
- The Importance of Medial Support in Locked Plating of Proximal Humerus FracturesJournal of Orthopaedic Trauma, 2007
- Management of complications after angularly stable locking proximal humerus plate fixationDer Chirurg, 2007