Artikel
Plate fixation of proximal humeral fractures: A comparative study of postoperative complications in two European countries
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Autoren
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Oliver Quaile
- Luzerner Kantonsspital, Unfallchirurgie, Luzern, Switzerland
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Björn-Christian Link
- Luzerner Kantonsspital Luzern, Klinik für Orthopädie und Unfallchirurgie, Luzern, Switzerland
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Reto Babst
- Luzerner Kantonsspital, Unfallchirurgie, Luzern, Switzerland
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Frank J. P. Beeres
- Klinik für Orthopädie und Unfallchirurgie, Kantonsspital Luzern, Luzern, Switzerland
| Veröffentlicht: | 23. Oktober 2017 |
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Gliederung
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Objectives: The primary aim was to evaluate the number of complications following locking plate fixation of proximal humeral fractures in the Netherlands and in Switzerland. The secondary aim was to identify risk factors for these complications.
Methods: Multicentre retrospective case series of 282 consecutive patients with proximal humeral fractures, treated with a locking plate between 2010 and 2014. Setting: two level 1 trauma centres in the Netherlands and one in Switzerland.
Data pertaining to demographics, postoperative complications and reoperations were collected. Fractures were classified according to the AO and Hertel classification. Postoperative x-rays were reviewed to assess the quality of reduction and plate fixation. Logistic regression analysis was performed to analyse the relationship between risk factors and complications.
Results: Results: During a median follow-up of 370 days (IQR = 259-471), 196 complications were encountered in 127 patients (45%). The most frequent complications were: screw perforation into the glenohumeral joint (23%), persistent shoulder complaints (16%), avascular necrosis (10.3%), and secondary fracture displacement (4.6%). In 80 patients (28.4%), 132 reoperations were performed. The Dutch patients had significantly more complications compared with the Swiss. Apart form related complications, advanced age, non-anatomic reduction of the greater tuberosity and country were risk factors.
Conclusion: The use of locking plates for proximal humeral fractures was associated with a high number of complications and reoperations in both countries.
With respect to differences between both countries, the Swiss patients had better results than the Dutch. There was a significant difference in the injury to surgery interval and the surgical approach between the two countries.
If locking plate osteosynthesis is applied, efforts must be made to obtain anatomic reduction of the greater tuberosity. Moreover the patient age should be taken into account, as there are significant more complications in elderly patients, as well as the experience of the surgeon with minimal invasive plate osteosynthesis of the proximal humerus.
