Outcomes of Dual Plate Fixation without Adjunctive Grafts in Complex Proximal Humerus Fractures.

Abstract

To assess the outcomes of a dual-plating fixation technique for proximal humerus fractures using a lateral locking plate and an additional anterior reduction plate, without the use of adjuvant grafts. Design: Retrospective study. Tertiary referral hospital. Included were adult patients with displaced proximal humerus fractures (OTA/AO 11A-C) who underwent dual plate fixation with a lateral locking plate and supplemental anterior plate, without adjunctive grafts, between 2018 and 2024. Primary outcomes were union rate and reoperations. Additional clinical outcomes including osteoarthritis (OA), avascular necrosis (AVN), head-shaft angle (HSA) and patient reported outcome measures at greater than 6 months post-op consisting of the QuickDASH and numerical rating scale for pain (NRSP), were evaluated. Forty patients were included (26 female, 65%) with an average age of 60.2 years (SD 15.1, range 27-86). There were 35 (87.5%) OTA/AO Type11B and 11C fractures and 5 (12.5%) with 11A fractures. Twenty-eight patients (70.0%) had 4-part fractures, 7 patients (17.5%) had 3-part fractures and 5 patients (12.5%) had a comminuted 2-part surgical neck fractures. Thirteen (32.5%) patients had medial comminution. The average follow-up was 25.8 months (SD 20.4, range 3.2-73.2). All patients achieved union after the index procedure (100%). Three patients (7.5%) required re-operation with RTSA due to AVN, and one had re-operation due to infection (2.5%). 97.5% healed with <10° loss of humeral head-shaft angle. Four patients (10.0%) showed radiologic signs of AVN resulting in articular screw penetration following fracture healing, and six (15.0%) had signs of OA. The average QuickDASH score was 18.3 (SD 16.1, range 0-59.1) and the average NRSP was 1.9 (SD 2.1, range 0-8). In a cohort of 40 patients with complex proximal humerus fractures (70.0% 4-part, 17.5% 3-part, 32.5% with medial comminution) treated with a lateral locking plate and an additional anterior plate without adjunctive grafts, the union rate was 100%, re-operations related to AVN occurred in three patients (7.5%) and patient reported outcomes were satisfactory at a minimum of 6 months. A level IV therapeutic retrospective cohort study.