Results of proximal humeral locked plating with supplemental suture fixation of rotator cuff

• Published in: Journal of shoulder and elbow surgery 2011-06, Vol.20 (4), p.616-624
• Main Authors: Badman, Brian, MD, Frankle, Mark, MD, Keating, Christopher, BS, Henderson, Leanne, PA-C, Brooks, Jordan, BS, Mighell, Mark, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Bone Plates; Diseases of the osteoarticular system; Female; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Humans; locked plating; Male; Medical sciences; Middle Aged; Orthopedics; Postoperative Care; Postoperative Complications - epidemiology; proximal humeral fracture; Radiography; Retrospective Studies; Rotator Cuff Injuries; Shoulder; Shoulder Fractures - diagnostic imaging; Shoulder Fractures - surgery; Suture Techniques; Treatment Outcome; Young Adult
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2010.08.030

Hypothesis This study retrospectively reports the results of 81 patients with proximal humeral fractures that were treated operatively. We hypothesized that treatment of these injuries through a standardized technique of precountored locked plating and supplemental tension band suture fixation would result in improved clinical outcomes. Materials and methods All patients were evaluated with a minimum follow-up of 1 year. Clinical assessment was performed postoperatively with American Shoulder and Elbow Surgeons (ASES) scores and active range of motion measurements. Radiographic parameters assessed included Neer fracture pattern, fracture union, hardware failure, the presence of avascular necrosis, and medial calcar length and stability. Fractures were classified as 4-part in 14 (17%), 3-part in 41 (51%), and 2-part in 26 (32%). Results The average ASES score was 80 (range, 27-100). The final range of motion averaged 131° of anterior elevation and 41° of external rotation. Fracture union was achieved in all patients, and there were no tuberosity failures. Complications included intraarticular screw penetration in 3 (3.7%) and avascular necrosis in 5 (6.2%). Discussion Locked plating and supplemental tension band fixation can lead to fracture union and favorable outcomes. Restoration of the medial calcar and supplemental suture fixation may decrease the incidence of hardware-related complications.