Screw-tip augmentation versus standard locked plating of displaced proximal humeral fractures: a retrospective comparative cohort study

This study compared the clinical and radiologic outcomes of screw tip–augmented locking plate osteosynthesis vs. standard locked plating in elderly patients with displaced proximal humeral fractures. Of the 94 patients older than 65 years with displaced proximal humeral fractures, 55 underwent fixation with a locking plate only whereas 39 underwent fixation using a locking plate with fluoroscopy-controlled polymethyl methacrylate augmentation of screw tips. At 2 years' follow-up, the locking plate–only group showed a mean Constant score (CS) of 62.6 ± 17.4 points, mean CS as a percentage of the uninjured side of 78.2% ± 18.9%, and mean age- and sex-adjusted CS of 72.4 ± 20.5 points. Among the 39 patients who underwent locked plating with polymethyl methacrylate augmentation of screw tips, the mean CS was 63.7 ± 18.5 points (P = .28), the mean CS as a percentage of the uninjured side was 79.5% ± 20.4% (P = .36), and the mean age- and sex-adjusted CS was 76.8 ± 26.2 points (P = .11). The mean Disabilities of the Arm, Shoulder and Hand score was 26.4 ± 21.3 in the locking plate–only group compared with 23.6 ± 19.2 in the group with screw tip–augmented locking plate osteosynthesis (P = .41). The overall complication rate was 16.3% in the locking plate–only group compared with 12.8% in the group with screw tip–augmented osteosynthesis (P = .86); loss of fixation occurred in 10.9% vs. 5.1% (P = .74). The follow-up rate was 81%. Loss of fixation was less frequent when augmentation of screw tips was performed; however, at the 2-year follow-up, the clinical and radiologic outcomes were not significantly different compared with standard locked plating without augmentation.