Novel Technical Factors Affecting Proximal Humerus Fixation Stability
| Autor: | G. Y. Laflamme, Dominique M. Rouleau, Stéphane Leduc, Philippe Moisan, Benoit Benoit, Julien Chapleau, Julien Goulet |
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| Rok vydání: | 2020 |
| Předmět: |
Radiography
medicine.medical_treatment Bone Screws 03 medical and health sciences Fixation (surgical) Fracture Fixation Internal 0302 clinical medicine Bone plate Fracture fixation medicine Internal fixation Humans Orthopedics and Sports Medicine Retrospective Studies Orthodontics 030222 orthopedics Calcar business.industry Trauma center 030208 emergency & critical care medicine General Medicine Middle Aged Radiological weapon Shoulder Fractures Surgery Female business Bone Plates |
| Zdroj: | Journal of orthopaedic trauma. 35(5) |
| ISSN: | 1531-2291 |
| Popis: | Objectives Intra-articular screw cut-out is a common complication after proximal humerus fracture (PHF) fixation using a locking plate. This study investigates novel technical factors associated with mechanical failures and complications in PHF fixation. Design A retrospective radiological study. Setting Level 1 trauma center. Patients/participants Clinical and radiological data from consecutive PHF patients treated between January 2007 and December 2013 were reviewed. Intervention Open reduction and internal fixation with the Synthes Philos locking plate. Main outcome measurements Postoperative radiographs were assessed for quality of initial reduction, humeral head offset, screw length, number and position, restoration of medial calcar support or the presence of calcar screws, and intra-articular screw perforations. Using SliceOMatic software, we validated a method to accurately identify screws of 45 mm or longer on AP radiographs. Follow-up radiographs were reviewed for complications. Results Among 110 patients included [mean age 60 years, 78 women (71%), follow-up 2.5 years] and the following factors were associated with a worse outcome. (1) Screws >45 mm in proximal rows [Odds Ratio (OR) = 5.3 for screw cut-out); (2) lateral translation of the humeral diaphysis over 6 mm (OR = 2.7 for loss of reduction); (3) lack in medial support by bone contact (OR = 4.9 for screw cut-out); (4) varus reduction increased the risk of complications (OR = 4.3). Conclusion The importance of reduction and calcar support in PHF fixation is critical. This study highlights some technical factors to which the surgeon must pay attention: avoid varus reduction, maximize medial support, avoid screws longer than 45 mm in the proximal rows, and restore the humeral offset within 6 mm or less. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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