Outcome of Proximal Humerus Fractures Treated Surgically by Locking Plate- a Retrospective Case-Series Study

Objectives: To evaluate functional outcomes, radiographic findings and complications of proximal humerus fractures(PHFs) treated surgically by osteosynthesis with locking plate(OLP)(Philos®), to determine unpredictable results after surgery and find out solutions for successful clinical outcomes. Patients and Methods: Twenty-five patients were evaluated retrospectively. Constant shoulder score, ASES shoulder score and range of motion(ROM) were used to evaluate clinical outcome. Preoperative and final follow-up radiographs were used and humeral neck-shaft inclination angle described by Boileau and avascular necrosis(AVN) of the humeral head evaluated by Cruess classification were recorded to judge radiological outcome. Results: Patients were 58(28-92) years old. The median Constant and ASES scores were 80(IQR 60-89) and 80(IQR 60-95) respectively. Neck-shaft inclination angle was 135(IQR 120-144) degrees at the final follow-up. 11 patients (44%) had complications. Major complications were AVN and varus malunion and both had a rate of 12% individually. Technical errors during surgery, mainly placing the pate high and screw-related complications, had adverse affect on AVN and varus malunion. Constant and ASES shoulder scores were not affected significantly by age, gender, AO and Neer fracture types and concomitant injuries. The clinical outcome has significantly become worse if varus malunion and/or AVN proceeded. Revision rate was 20% and its leading cause was AVN. Conclusion: Age, gender, fracture type and additional fracture elsewhere did not affect clinical outcome significantly. OLP is a reliable option for PHFs that can be used in all age groups and fracture types. OLP for PHFs had favorable radiological and clinical outcomes unless varus malunion and/or AVN of the humeral head proceeded postoperatively.