Birsel Olgar, Eren İlker, Chodza Mehmet, Koyuncu Özgür, Demirhan Mehmet
Department of Orthopaedics and Traumatology, Shoulder and Elbow Unit, Koç University School of Medicine, Istanbul, Turkey.
Department of Orthopaedics and Traumatology, Shoulder and Elbow Unit, Koç University School of Medicine, Istanbul, Turkey.
J Shoulder Elbow Surg. 2025 Jul 29. doi: 10.1016/j.jse.2025.06.012.
The long-term outcomes of open reduction and internal fixation with anatomical locking plates for proximal humerus fractures (PHFs) remain under-reported. Most literature has focused on short- to mid-term results, with limited data beyond a decade. This study aimed to evaluate the clinical and radiological outcomes at a minimum of 10 years postoperatively, in a consecutive series managed with a standardized surgical technique.
From 2006 to 2015, 120 patients with PHFs were treated with open reduction and internal fixation using Proximal Humerus Inter Locking System by a single surgeon. At final review (mean follow-up, 14.9 years), 49 shoulders (in 48 patients) were available for full clinical and radiographic evaluation. Functional outcomes were assessed using the normalized Constant Score and Subjective Shoulder Value. Radiographic analysis included neck-shaft angle, osteoarthritis grade, avascular necrosis (AVN), and implant-related complications.
The mean normalized Constant Score was 88.7 and the mean Subjective Shoulder Value was 89.7. Mean elevation and external rotation were 149.5° and 52.9°, respectively. Strength in elevation and external rotation was significantly lower compared to the contralateral side (P < .001). High-grade osteoarthritis (grades 3-4) was observed in 8 shoulders (16%), with AVN identified in 6 of those. The overall complication rate was 26.5%, with AVN being the most common (12.2%). Screw penetration occurred in 6 shoulders (12.2%), primarily secondary to AVN or varus collapse. No infections or nonunions were recorded. The reoperation rate was 12.2%, all within the first 2 years postoperatively. No patient required revision arthroplasty during follow-up.
Locking plate fixation for PHFs provides favorable long-term results, with low reoperation rates and acceptable functional outcomes. Despite limitations in external rotation strength and a 16% rate of high-grade osteoarthritis, most patients reported high satisfaction. These findings support the use of anatomical locking plates as a durable option for selected proximal humerus fractures, particularly when internal fixation is clearly indicated as the preferred treatment approach.
肱骨近端骨折（PHF）采用切开复位解剖锁定钢板内固定的长期疗效报道较少。大多数文献聚焦于短期至中期结果，超过十年的数据有限。本研究旨在评估采用标准化手术技术连续治疗的患者术后至少10年的临床和影像学结果。
2006年至2015年，120例PHF患者由同一外科医生采用肱骨近端锁定系统进行切开复位内固定治疗。在最终随访（平均随访14.9年）时，49例肩部（48例患者）可进行全面的临床和影像学评估。使用标准化的Constant评分和主观肩关节评分评估功能结果。影像学分析包括颈干角、骨关节炎分级、缺血性坏死（AVN）和植入物相关并发症。
平均标准化Constant评分为88.7，平均主观肩关节评分为89.7。平均抬高和外旋分别为149.5°和52.9°。与对侧相比，抬高和外旋力量明显降低（P <.001）。8例肩部（16%）观察到高级别骨关节炎（3 - 4级），其中6例伴有AVN。总体并发症发生率为26.5%，AVN最为常见（12.2%）。6例肩部（12.2%）发生螺钉穿透，主要继发于AVN或内翻塌陷。未记录感染或骨不连。再手术率为12.2%，均发生在术后2年内。随访期间无患者需要翻修关节成形术。
PHF的锁定钢板固定提供了良好的长期结果，再手术率低，功能结果可接受。尽管外旋力量存在局限性且高级别骨关节炎发生率为16%，但大多数患者报告满意度高。这些发现支持将解剖锁定钢板作为特定肱骨近端骨折的持久选择，特别是当明确指示内固定为首选治疗方法时。
