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Factors associated with failure of locking plate fixation in proximal humerus fractures

Filip Cosic, Nathan Kirzner, Elton Edwards, Richard Page, Lara Kimmel, Belinda Gabbe Orcid Logo

Injury, Volume: 56, Issue: 2, Start page: 112024

Swansea University Author: Belinda Gabbe Orcid Logo

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DOI (Published version): 10.1016/j.injury.2024.112024

Abstract

Locking plate fixation remains the mainstay of surgical fixation of unstable proximal humerus fractures, however rates of failure remain high. The aim of this study was to identify risk factors that could be used to predict the likelihood of fixation failure. Patients with proximal humerus fractures...

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Published in: Injury
ISSN: 0020-1383 1879-0267
Published: Elsevier BV 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa68567
first_indexed 2025-01-09T20:33:50Z
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spelling 2024-12-13T12:15:27.8099966 v2 68567 2024-12-13 Factors associated with failure of locking plate fixation in proximal humerus fractures 4bdcc94332b2bd10530c5e71ceb04f14 0000-0001-7096-7688 Belinda Gabbe Belinda Gabbe true false 2024-12-13 MEDS Locking plate fixation remains the mainstay of surgical fixation of unstable proximal humerus fractures, however rates of failure remain high. The aim of this study was to identify risk factors that could be used to predict the likelihood of fixation failure. Patients with proximal humerus fractures managed with locking plate fixation between 2010 and 2019 at a Level 1 trauma centre were included. Radiographs were evaluated for parameters that could be used to predict failure of fixation. Pre-operative factors included were the Neer classification, cephalomedullary angle, medial calcar length, disruption of the medial hinge, and anatomical neck fracture. Post-operative factors included the cephalomedullary angle, medial calcar reduction gap, presence of anatomical tuberosity reduction, presence of medial calcar screws, screw distance to articular surface, and number of screws present in the humeral head. There were 189 patients included; 54 % male, mean age 49.9 (intact fixation) group and 56.1 (failure). The rate of fixation failure was 22 %. Factors associated with increased risk of failure following multivariable analysis included increasing age (OR 1.04 per year, CI 1.01-1.07), varus pre-operative cephalomedullary angle (OR 2.84, CI 1.03-7.83), and non-anatomical calcar reduction (OR 2.31, CI 1.05-5.08). The presence of calcar screws was associated with decreased risk of fixation failure (OR 0.30, CI 0.10-0.90). This analysis was used to create a predictive model including the Neer classification, age, pre-operative cephalomedullary angle, post-operative cephalomedullary angle, anatomic reduction of the medial calcar, and presence of medial calcar screws. Rates of locking plate fixation failure in proximal humerus fractures remain high. This study has identified key pre-operative and intra/post-operative factors that can be used to predict the risk of failure. Further work is required to validate this model. Level II. Journal Article Injury 56 2 112024 Elsevier BV 0020-1383 1879-0267 Humeral fracture, proximal, Internal fixation, Shoulder fractures, Fracture fixation, internal 1 2 2025 2025-02-01 10.1016/j.injury.2024.112024 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee VOTOR is funded by the Transport Accident Commission. Belinda Gabbe is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (fellowship number 2009998). 2024-12-13T12:15:27.8099966 2024-12-13T12:09:00.2108488 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Filip Cosic 1 Nathan Kirzner 2 Elton Edwards 3 Richard Page 4 Lara Kimmel 5 Belinda Gabbe 0000-0001-7096-7688 6
title Factors associated with failure of locking plate fixation in proximal humerus fractures
spellingShingle Factors associated with failure of locking plate fixation in proximal humerus fractures
Belinda Gabbe
title_short Factors associated with failure of locking plate fixation in proximal humerus fractures
title_full Factors associated with failure of locking plate fixation in proximal humerus fractures
title_fullStr Factors associated with failure of locking plate fixation in proximal humerus fractures
title_full_unstemmed Factors associated with failure of locking plate fixation in proximal humerus fractures
title_sort Factors associated with failure of locking plate fixation in proximal humerus fractures
author_id_str_mv 4bdcc94332b2bd10530c5e71ceb04f14
author_id_fullname_str_mv 4bdcc94332b2bd10530c5e71ceb04f14_***_Belinda Gabbe
author Belinda Gabbe
author2 Filip Cosic
Nathan Kirzner
Elton Edwards
Richard Page
Lara Kimmel
Belinda Gabbe
format Journal article
container_title Injury
container_volume 56
container_issue 2
container_start_page 112024
publishDate 2025
institution Swansea University
issn 0020-1383
1879-0267
doi_str_mv 10.1016/j.injury.2024.112024
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 0
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description Locking plate fixation remains the mainstay of surgical fixation of unstable proximal humerus fractures, however rates of failure remain high. The aim of this study was to identify risk factors that could be used to predict the likelihood of fixation failure. Patients with proximal humerus fractures managed with locking plate fixation between 2010 and 2019 at a Level 1 trauma centre were included. Radiographs were evaluated for parameters that could be used to predict failure of fixation. Pre-operative factors included were the Neer classification, cephalomedullary angle, medial calcar length, disruption of the medial hinge, and anatomical neck fracture. Post-operative factors included the cephalomedullary angle, medial calcar reduction gap, presence of anatomical tuberosity reduction, presence of medial calcar screws, screw distance to articular surface, and number of screws present in the humeral head. There were 189 patients included; 54 % male, mean age 49.9 (intact fixation) group and 56.1 (failure). The rate of fixation failure was 22 %. Factors associated with increased risk of failure following multivariable analysis included increasing age (OR 1.04 per year, CI 1.01-1.07), varus pre-operative cephalomedullary angle (OR 2.84, CI 1.03-7.83), and non-anatomical calcar reduction (OR 2.31, CI 1.05-5.08). The presence of calcar screws was associated with decreased risk of fixation failure (OR 0.30, CI 0.10-0.90). This analysis was used to create a predictive model including the Neer classification, age, pre-operative cephalomedullary angle, post-operative cephalomedullary angle, anatomic reduction of the medial calcar, and presence of medial calcar screws. Rates of locking plate fixation failure in proximal humerus fractures remain high. This study has identified key pre-operative and intra/post-operative factors that can be used to predict the risk of failure. Further work is required to validate this model. Level II.
published_date 2025-02-01T20:36:52Z
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score 11.04748

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