Session IX - Upper Extremity

Sat., 10/12/13 Upper Extremity, PAPER #101, 2:55 pm OTA 2013

Can Complications of Locked Plating About the Proximal Humerus Fractures Be Minimized? The Effect of the Learning Curve

Kenneth A. Egol, MD1,2; Brandon S. Shulman, BA1; Crispin C. Ong, MD1;
David P. Taormina, MS1; Raj J. Karia, MPH1; Joseph D. Zuckerman, MD1;
1NYU Hospital for Joint Diseases, New York, New York, USA;
2Jamaica Medical Center, Jamaica, New York, USA

Background/Purpose: We previously reported on early complications of proximal humerus fractures treated with locked plates. In 51 consecutive patients, we found a complication rate of 24%, the most common of which was screw penetration. Other recent studies have reported complication rates as high as 43% for proximal humerus fractures treated with locking plates. The purpose of this study was to reassess the incidence of complications following locking plate treatment of proximal humerus fractures (OTA Types 11) to determine if the effect of the learning curve could diminish these outcomes.

Methods: 163 consecutive patients with proximal humerus fractures were prospectively tracked following operative fracture fixation with a locking plate. All patients were treated between February 2003 and July 2012 at our institution, and received similar treatment of open reduction and internal fixation with a locked plate followed by early range of shoulder motion. The only difference in the surgical technique over time was a greater use of calcium phosphate cement as a bone void filler in more recently treated patients. Patient outcomes were assessed by radiographic examination and physical exam. All complications were recorded. Subgroup analysis for correlation with complication was performed for age, gender, body mass index, fracture type, mechanism of injury, and number of screws in the humeral head.

Results: Overall 30 of 163 patients (18%) had experienced a complication by the time of most recent follow-up (mean 16 months; range, 6-60 months). Of the 112 patients not included in our previous study, 18 patients (16%) developed 26 complications. Average fracture healing time was 3.7 months (range, 1.5-8 months). Only 6 of 112 patients (5%) had screw penetration, yet in our previous study 8 of 51 patients (16%) had screw penetration. The incidence of infection, hardware failure, and osteonecrosis remained low and largely unchanged. There was one intraoperative complication in the latter cohort.

Conclusions: As with most procedures, a learning curve with this procedure does appear to exist. The lower complication rate in our more recent patients suggests that complications reported in early locked plating series are not inherent to the implant or fracture. They can be diminished when surgeons and support teams frequently treat proximal humerus fractures, and/or employ new treatment strategies.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.