Path analysis of factors for functional outcome at one year in 463 proximal humeral fractures

Which parameters affect medium- to long-term results after angular stable plate fixation for proximal humeral fractures?

“…It demonstrated that being a woman (>40 years), being treated with a locking proximal humeral plate, having experienced intraoperative and local post-treatment complications, and having varus deformity of >30 were negative predictors of the Constant score. 25 Most important, we demonstrated that a residual bone deformity and therefore initial reconstruction within a range of 15 in both views and <5-mm tuberosity displacement is acceptable and should be the surgical aim of head-preserving surgery with an angular stable plate independent of the result of the classification and the existence of an osteoporosis. The most relevant complicationdbecause of significant influence on revision rate and clinical outcomedwas the screw perforation.…”

Classifications in Brief: The Neer Classification for Proximal Humerus Fractures

“…These attributes contribute to decreased biomechanical stability after open reduction and internal fixation and consequently are associated with varus collapse, articular screw penetration, and lesser outcomes [22,27,28,31]. None of the above factors are absolute contraindications to internal fixation, but the alternatives of hemiarthroplasty or nonoperative management might be more heavily considered in those situations.…”

“…Two meta-analyses have shown that the Constant-Murley scores decrease as the number of Neer fracture parts increases [29,32]. A regression analysis showed that this predictive value is largely explained by a correlation between intraoperative and postoperative complications and increased parts [31].…”

Quality of Life After Osteosynthesis of Fractures of the Proximal Humerus

“…Consistent with earlier reports, more severe fracture patterns performed worse for all scores. 31,32 Older patients suffered from more complex fracture types and these parameters cumulatively influenced the result. Fracture dislocation also lowered MCS during the first year, probably because these injuries go along with the worst functional outcome (in SF-36 and CMS).…”