Complications of the locking plate for displaced proximal humeral fractures

Background Although the locking plate has become popular for treating displaced proximal humeral fractures in recent years, the complications of this method are still underestimated. We tried to evaluate the factors that have an influence on the complications experienced after proximal humeral fractures fixed by locking plates and compare the results from patients having complications with those having no complications. Methods From September 2004 to September 2007, 92 out of 111 displaced proximal humeral fractures treated by open reduction and internal fixation with a locking plate were available for follow-up, with an average time of 15.2 months （12-36 months）. The range of motion, Visual Analog Score （VAS） for pain, American Shoulder and Elbow Surgeons＇ Form （ASES）, Constant-Murley, University of California-Los Angles scoring system （UCLA） score, and Simple Shoulder Test （SST） for function evaluation was all recorded at the latest follow-up. The results from patients with complications were evaluated according to the indices listed above and compared with those patients without any complications. Results There were 17 patients with complications, an 18.5% complication rate. Among them, the forward flexion, external rotation and internal rotation were 139.1°±24.3°, 24.1°±19.6°, and up to T10 level on average. The mean VAS score was 1.0±1.1, the ASES score was 82.9±13.8, the Constant 82.1±11.8, the UCLA 28.5±4.1 and the mean SST 9.5 on average. There was no significant difference of complication rate among different age, sex, and injured side, fresh or delayed fracture, combined with other injury or not groups. Compared with the group without complications, patients with complications showed significantly less external rotation and lower Constant-Murley and UCLA functional scores （P 〈0.05）. A significant difference in results was seen between patients with complications and those without complications. Conclusion The indication control and appropriate surgical technique were important while performing the locking plate fixation for proximal humeral fractures.