• Eur J Trauma Emerg Surg · Dec 2021

    Complication rate after operative treatment of three- and four-part fractures of the proximal humerus: locking plate osteosynthesis versus proximal humeral nail.

    • Greta Lorenz, Wolfgang Schönthaler, Wolfgang Huf, Micha Komjati, Christian Fialka, and Sandra Boesmueller.
    • Department of Trauma Surgery, AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria. greta.lorenz@auva.at.
    • Eur J Trauma Emerg Surg. 2021 Dec 1; 47 (6): 2055-2064.

    PurposeThere is still disagreement regarding the optimal surgical treatment of three- and four-part fractures of the proximal humerus. The aim of this monocentric, retrospective study was to compare the complication rate of internal fixation with a locking plate versus proximal humeral nailing after a one-year follow-up.MethodsFrom 2005 to 2016, 292 patients suffered a fracture of the proximal humerus and were treated surgically at our level-I trauma center. According to the inclusion criteria, 50 patients were included in this study: 19 of these (11 three-part fractures and 8 four-part fractures) were treated with a proximal humeral nail (HN) and 31 (12 three-part fractures and 19 four-part fractures) with a locking plate (LP) osteosynthesis. Classification was performed according to the Hertel classification. At a 1-year follow-up, the complication rate of the two treatment methods was compared.ResultsTwenty patients (40%) suffered at least one complication. Of these, six patients (12%) were treated with a HN and 14 (28%) with a LP (p = 0.39). The most frequent complication was screw perforation (22%), followed by non-union (16%). Humeral head necrosis (10%) occurred only in the LP cohort. One wound infection occurred in a patient treated with a HN. Four-part fractures were treated more frequently with a LP. However, the difference was non-significant in this sample (p = 0.186).ConclusionsThe results of our study provide some evidence that in terms of complication rate, both treatment options are comparable for internal fixation of three- and four-part fractures of the proximal humerus. The type of fracture seems to be decisive for the choice of implant.© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.

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