Failure of Proximal Humeral Fractures Osteosynthesis - Radiological Evaluation of Predictive Factors
Ana Sofia Esteves, MD1*, Tatiana Alexandra Salazar, MD1, Luís Ferreira Pinto, MD1 and João Manuel Torres, MD, FEBOT2
1 Traumatology and Orthopedics Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.
2 Traumatology and Orthopedics Department, Centro Hospitalar S. João, Porto, Portugal.
*Corresponding Author: Dr. Ana Sofia Esteves, Traumatology and Orthopedics Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.
Received: January 03, 2022 Published: February 09, 2022
Abstract
The surgical treatment of proximal humeral fractures (PHF) remains a source of debate and research. Open reduction and internal fixation (ORIF) has become more popular with the advent of locking plates. However, it is associated with a significant rate of failure. The purpose of this study is to describe several radiological factors that can be predictive of failure in PHF osteosynthesis. A revision of all records of PHF treated with ORIF between January 2005 and December 2017 was performed and specific variables were measured in pre, post and two months radiographs. A total of 91 shoulders were analyzed. Osteosynthesis failure (dismantling) was observed in 42% of patients and it was associated with comminuted fractures (p=0.001). The use of locked plates (p=0.001) and calcar reconstruction (p=0.001) were related to a lower risk for dismantling. Cut-out was observed in 20% of patients and it was associated with tip to the apex distance (p=0.004). Higher cervicodiaphyseal angles were related to lower risk for dismantling and cut-out. Four radiological factors of PHF can be used to predict the final radiological outcome of PHF osteosynthesis: comminuted fracture pattern, the use of locked plates, calcar reconstruction, tip to the apex distance and the cervicodiaphyseal angles.
Keywords: Open reduction and internal fixation; proximal humeral fractures; radiological factors; osteosynthesis failure; cut-out; plate fixation.
Citation: Esteves AS, Salazar TA, Pinto LF, Torres M. “Failure of Proximal Humeral Fractures Osteosynthesis - Radiological Evaluation of Predictive Factors”. SVOA Orthopaedics 2:1 (2022) Pages 25-29.