The influence of biplanar reduction and surgeon experience on proximal humerus fractures treated with ORIF

• Published in: Injury 2020-02, Vol.51 (2), p.322-328
• Main Authors: Liskutin, Tomas, Harkin, Elizabeth, Summers, Hobie, Cohen, Joseph, Bernstein, Mitchell, Lack, William
• Format: Article
• Language: English
• Subjects: Locking plate; Open reduction internal fixation; Proximal humerus fractures; Trauma
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.11.030

•Demonstrates sagittal plane reduction and medial calcar disruption were synergistically associated complications.•Reveals that reduction quality significantly improved with surgeon experience.•Proposes important factors to consider in future clinical studies of operative treatment for proximal humerus fractures. Treatment for proximal humerus fractures remains controversial. Studies of open reduction and internal fixation (ORIF) rarely account for reduction quality, while surgeon experience and sagittal plane reduction remain unstudied. In a retrospective case series analysis of AO/OTA C-type proximal humerus fractures treated with ORIF using a locking plate, we hypothesized that reduction quality would be associated with outcome, and reductions would improve with experience. We retrospectively identified 41 3- and 4-part proximal humerus fractures treated with ORIF by a single orthopaedic traumatologist. Two blinded traumatologists assessed injury and post-operative radiographs for medial calcar disruption and five measures of deformity. Major complications and functional outcome were assessed. Outcome by ASES score was similar to previous reports (mean 73.6, std dev 22.5). Eleven of 35 patients (31.4%) with greater than six months follow-up experienced a complication. Post-reduction sagittal HSa