Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
J Orthop Surg Res. 2023 May 19;18(1):374. doi: 10.1186/s13018-023-03811-8.
Open reduction and plate internal fixation (ORIF) is one of the most common treatment methods for proximal humeral fractures. Complications associated with the greater tuberosity (GT) are rarely reported, therefore, the purpose of this study was to analyze the complications associated with the GT and the risk factors after locked-plate internal fixation.
We retrospectively analyzed the medical and radiographic data of patients with proximal humeral fractures involving the GT treated with locking plates between January 2016 and July 2019. We divided all patients into two groups, the anatomic GT healing group and the nonanatomic GT healing group, depending on the radiographic outcomes of the GT. Clinical outcome was assessed by the Constant scoring system. Potential risk factors included preoperative and intraoperative factors. Preoperative factors included sex, age, body mass index, fracture type, fracture-dislocation, proximal humeral bone mineral density, humeral head extension, hinge integrity, comminuted GT, volume and surface area of the main GT fragment, and displacement of the main GT fragment. Intraoperative factors were adequate medial support, residual head-shaft displacement, head-shaft angle and residual GT displacement. Univariate logistic regression and multivariate logistic regression were used to identify risk factors.
There were 207 patients (130 women and 77 men; mean age, 55 years). GT anatomic healing was observed in 139 (67.1%) patients and nonanatomic healing in 68 (32.9%). Patients with GT nonanatomic healing had significantly inferior Constant scores than those with GT anatomic healing (75.0 ± 13.9 vs. 83.9 ± 11.8, P < 0.001). Patients with high GT malposition had worse Constant scores than patients with low GT malposition (73.3 ± 12.7 vs. 81.1 ± 11.4, P = 0.039). The multivariate logistic model showed that GT fracture characteristics were not risk factors for nonanatomic GT healing, while residual GT displacement was.
Nonanatomic healing of the GT is a high-rate complication of proximal humeral fractures, resulting in inferior clinical outcomes, especially for high GT malposition. Fracture characteristics of the GT are not risk factors for GT nonanatomic healing and GT comminution should not be regarded as a contraindication to ORIF for proximal humeral fractures.
切开复位钢板内固定（ORIF）是治疗肱骨近端骨折的最常用方法之一。与大结节（GT）相关的并发症很少见报道，因此，本研究旨在分析锁定钢板内固定治疗肱骨近端骨折后与 GT 相关的并发症及其危险因素。
我们回顾性分析了 2016 年 1 月至 2019 年 7 月采用锁定钢板治疗涉及 GT 的肱骨近端骨折患者的临床和影像学资料。我们根据 GT 的影像学结果将所有患者分为解剖 GT 愈合组和非解剖 GT 愈合组。采用 Constant 评分系统评估临床疗效。潜在的危险因素包括术前和术中因素。术前因素包括性别、年龄、体重指数、骨折类型、骨折脱位、肱骨近端骨密度、肱骨头伸展、铰链完整性、粉碎性 GT、主 GT 骨块的体积和表面积以及主 GT 骨块的移位。术中因素包括内侧充分支撑、残余头干移位、头干角和残余 GT 移位。采用单因素和多因素 logistic 回归分析确定危险因素。
共纳入 207 例患者（130 例女性，77 例男性；平均年龄 55 岁）。139 例（67.1%）患者 GT 解剖愈合，68 例（32.9%）患者 GT 非解剖愈合。GT 非解剖愈合患者的 Constant 评分明显低于 GT 解剖愈合患者（75.0±13.9 比 83.9±11.8，P<0.001）。GT 高错位患者的 Constant 评分明显低于 GT 低错位患者（73.3±12.7 比 81.1±11.4，P=0.039）。多因素 logistic 模型显示 GT 骨折特征不是 GT 非解剖愈合的危险因素，而残余 GT 移位是 GT 非解剖愈合的危险因素。
GT 非解剖愈合是肱骨近端骨折的高发生率并发症，导致临床结果较差，尤其是 GT 高错位患者。GT 骨折特征不是 GT 非解剖愈合的危险因素，GT 粉碎性骨折不应作为肱骨近端骨折切开复位内固定的禁忌证。
