A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications
The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse ev...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/3/1216 |
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| author | Sebastian Kwisda Jan-Philipp Imiolczyk Tankred Imiolczyk Magdalena Werth Markus Scheibel |
| author_facet | Sebastian Kwisda Jan-Philipp Imiolczyk Tankred Imiolczyk Magdalena Werth Markus Scheibel |
| author_sort | Sebastian Kwisda |
| collection | DOAJ |
| description | The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This prospective cohort study included 50 patients with a mean age of 63.2 (range 28–92) years treated by one single surgeon using a previously published standardized surgical protocol. Clinical and radiological follow-up examinations were conducted for up to 24 months using Constant–Murley Score (CS), Subjective Shoulder Value (SSV) and radiographs in true anteroposterior, axial and y-view. Finally, CS was 73.9 (standard deviation [SD]: 14.0) points (89% compared to the uninjured shoulder), and SSV was 83.3% (SD: 16.7) at two years of follow-up. Postoperative radiologic evaluation revealed no primary surgical-related or soft-tissue-related complications (0%). The main complications were secondary, biological complications (20%), largely represented by avascular necrosis (8%). Eight patients underwent revision surgery, mainly for implant removal. In addition, a total of four patients were revised using a hemiarthroplasty (n = 2), reverse shoulder arthroplasty (n = 1) or re-osteosynthesis. The use of our standardized surgical technique on proximal humerus fractures improves fixation with regard to primary stability and prevents primary, surgical-technique-related complications. The subjective grading of a high level of difficulty surgery was associated with more complications. |
| first_indexed | 2024-03-11T09:36:06Z |
| format | Article |
| id | doaj.art-050ed0696f17417b97da11f3bf21016b |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T09:36:06Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-050ed0696f17417b97da11f3bf21016b2023-11-16T17:13:25ZengMDPI AGJournal of Clinical Medicine2077-03832023-02-01123121610.3390/jcm12031216A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related ComplicationsSebastian Kwisda0Jan-Philipp Imiolczyk1Tankred Imiolczyk2Magdalena Werth3Markus Scheibel4Department of Shoulder and Elbow Surgery, Schulthess Clinic, 8008 Zurich, SwitzerlandCenter for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, 13353 Berlin, GermanyDepartment of Mathematics, University of Mannheim, 68131 Mannheim, GermanyCenter for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, 13353 Berlin, GermanyCenter for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, 13353 Berlin, GermanyThe current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This prospective cohort study included 50 patients with a mean age of 63.2 (range 28–92) years treated by one single surgeon using a previously published standardized surgical protocol. Clinical and radiological follow-up examinations were conducted for up to 24 months using Constant–Murley Score (CS), Subjective Shoulder Value (SSV) and radiographs in true anteroposterior, axial and y-view. Finally, CS was 73.9 (standard deviation [SD]: 14.0) points (89% compared to the uninjured shoulder), and SSV was 83.3% (SD: 16.7) at two years of follow-up. Postoperative radiologic evaluation revealed no primary surgical-related or soft-tissue-related complications (0%). The main complications were secondary, biological complications (20%), largely represented by avascular necrosis (8%). Eight patients underwent revision surgery, mainly for implant removal. In addition, a total of four patients were revised using a hemiarthroplasty (n = 2), reverse shoulder arthroplasty (n = 1) or re-osteosynthesis. The use of our standardized surgical technique on proximal humerus fractures improves fixation with regard to primary stability and prevents primary, surgical-technique-related complications. The subjective grading of a high level of difficulty surgery was associated with more complications.https://www.mdpi.com/2077-0383/12/3/1216proximal humerus fractureangular stable platingstandardized surgical protocoladverse eventscomplicationbiological |
| spellingShingle | Sebastian Kwisda Jan-Philipp Imiolczyk Tankred Imiolczyk Magdalena Werth Markus Scheibel A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications Journal of Clinical Medicine proximal humerus fracture angular stable plating standardized surgical protocol adverse events complication biological |
| title | A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications |
| title_full | A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications |
| title_fullStr | A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications |
| title_full_unstemmed | A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications |
| title_short | A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications |
| title_sort | standardized operative protocol for fixation of proximal humeral fractures using a locking plate to minimize surgery related complications |
| topic | proximal humerus fracture angular stable plating standardized surgical protocol adverse events complication biological |
| url | https://www.mdpi.com/2077-0383/12/3/1216 |
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