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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2011

Open Access 01-12-2011 | Research article

The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study

Authors: Georg Osterhoff, Christian Ossendorf, Guido A Wanner, Hans-Peter Simmen, Clément M Werner

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2011

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Abstract

Background

With new minimally-invasive approaches for angular stable plate fixation of proximal humeral fractures, the need for the placement of oblique inferomedial screws ('calcar screw') has increasingly been discussed. The purpose of this study was to investigate the influence of calcar screws on secondary loss of reduction and on the occurrence of complications.

Methods

Patients with a proximal humeral fracture who underwent angular stable plate fixation between 01/2007 and 07/2009 were included. On AP views of the shoulder, the difference in height between humeral head and the proximal end of the plate were determined postoperatively and at follow-up. Additionally, the occurrence of complications was documented. Patients with calcar screws were assigned to group C+, patients without to group C-.

Results

Follow-up was possible in 60 patients (C+ 6.7 ± 5.6 M/C- 5.0 ± 2.8 M). Humeral head necrosis occurred in 6 (C+, 15.4%) and 3 (C-, 14.3%) cases. Cut-out of the proximal screws was observed in 3 (C+, 7.7%) and 1 (C-, 4.8%) cases. In each group, 1 patient showed delayed union. Implant failure or lesions of the axillary nerve were not observed. In 44 patients, true AP and Neer views were available to measure the head-plate distance. There was a significant loss of reduction in group C- (2.56 ± 2.65 mm) compared to C+ (0.77 ± 1.44 mm; p = 0.01).

Conclusions

The placement of calcar screws in the angular stable plate fixation of proximal humeral fractures is associated with less secondary loss of reduction by providing inferomedial support. An increased risk for complications could not be shown.
Appendix
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Metadata
Title
The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study
Authors
Georg Osterhoff
Christian Ossendorf
Guido A Wanner
Hans-Peter Simmen
Clément M Werner
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2011
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/1749-799X-6-50

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