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Orthop Traumatol Surg Res. 2014 May;100(3):271-4. doi: 10.1016/j.otsr.2013.12.024. Epub 2014 Apr 4.

Radiological evaluation of reduction loss in unstable proximal humeral fractures treated with locking plates.

Author information

  • 1Department of Orthopedics and Traumatology, Peking University People's Hospital, Traffic Medicine Center, XiZhiMen South Avenue 11#, 100044 Beijing, PR China.
  • 2Department of Orthopedics and Traumatology, Peking University People's Hospital, Traffic Medicine Center, XiZhiMen South Avenue 11#, 100044 Beijing, PR China. Electronic address: zhangpeixun@bjmu.edu.cn.
  • 3Department of Orthopedics and Traumatology, Peking University People's Hospital, Traffic Medicine Center, XiZhiMen South Avenue 11#, 100044 Beijing, PR China. Electronic address: jiangbaoguo@vip.sina.com.

Abstract

PURPOSE:

The aim of this study was to radiologically evaluate the risk of reduction loss after locking plate fixation of proximal humerus fractures.

METHODS:

From September 2007 to April 2009, 71 patients (28 males, 43 females) with unstable proximal humeral fracture were treated with open reduction and internal fixation by locking plate. The mean follow-up time was 31.2 months (range: 26-47). The head-shaft angulation (HSA) and the humeral head height (HHH) in true anteroposterior (AP) were recorded and compared over time. All complications were noted. Shoulder function was measured by the Constant score.

RESULTS:

Patients with ΔHSA >10° (t=2.740, P=0.008) and ΔHHH >5mm (t=2.55, P=0.019) were more likely to have impaired shoulder function. Varus collapse occurred most frequently in patients with initial reduction of HSA <125° (χ(2)=19.17, P<0.001, Fisher's exact test F<0.001). Patients with >5mm HHH decrease were strongly associated with loss of reduction (χ(2)=24.23, P<0.001, F<0.001).

CONCLUSIONS:

Dynamic change of HSA >10° and HHH >5mm were radiological factors that indicated poor shoulder function. Intra-operative HSA >125° should be achieved to avoid reduction loss following locking plate fixation of proximal humerus fracture.

LEVEL OF EVIDENCE:

level IV.

Copyright © 2014. Published by Elsevier Masson SAS.

KEYWORDS:

Head-shaft angulation; Humeral head height; Locking plate; Loss of reduction; Proximal humerus fracture; Shoulder function

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