Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Elective implant removal in symptomatic patients after internal fixation of proximal humerus fractures improves clinical outcome

Authors: Yves P. Acklin, Christian Michelitsch, Christoph Sommer

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Login to get access

Abstract

Background

Operative treatment is the standard for severely displaced proximal humerus fractures, but functional impairment can persist. Retaining of the implant can be a reason and in other fracture situations has proved to ameliorate patient satisfaction. The aim of this study was to analyse the functional outcome after locking plate removal in proximal humerus fractures.

Methods

In a two-year period, all symptomatic patients with plate osteosynthesis for proximal humerus fracture and hardware removal were retrospectively evaluated clinically and radiologically pre- and post-implant removal. Evaluation included Constant score, height of plate position and possible impingement, as well as intraoperative complications.

Results

Twenty patients met the inclusion criteria. The mean age was 56 ± 12 years. The plates were placed 6.9 ± 3 mm distal to the greater tubercle. The operation was performed in 35 ± 10 min and no intraoperative complications were reported. The Constant score improved significantly after implant removal from 71 to 76 (p = 0.008).

Conclusion

Symptomatic patients after locked plate osteosynthesis for proximal humerus fractures showed statistically significant improvement of the Constant score after implant removal.
Literature
1.
go back to reference Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. [Treatment of proximal humeral fractures with the PHILOS angular stable plate. Presentation of 225 cases of dislocated fractures]. Unfallchirurg. 2006;109:1032–40.CrossRefPubMed Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. [Treatment of proximal humeral fractures with the PHILOS angular stable plate. Presentation of 225 cases of dislocated fractures]. Unfallchirurg. 2006;109:1032–40.CrossRefPubMed
2.
go back to reference Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87–92.CrossRefPubMed Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87–92.CrossRefPubMed
3.
go back to reference Hirschmann MT, Fallegger B, Amsler F, Regazzoni P, Gross T. Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma. 2011;25:286–93.CrossRefPubMed Hirschmann MT, Fallegger B, Amsler F, Regazzoni P, Gross T. Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma. 2011;25:286–93.CrossRefPubMed
4.
go back to reference Acklin YP, Stoffel K, Sommer C. A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures. Injury. 2012;44(4):456–60.CrossRefPubMed Acklin YP, Stoffel K, Sommer C. A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures. Injury. 2012;44(4):456–60.CrossRefPubMed
5.
go back to reference Bostman O, Pihlajamaki H. Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units. J Trauma. 1996;41:846–9.CrossRefPubMed Bostman O, Pihlajamaki H. Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units. J Trauma. 1996;41:846–9.CrossRefPubMed
6.
7.
go back to reference Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–4.PubMed Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–4.PubMed
8.
go back to reference Acklin YP, Sommer C. Plate fixation of proximal humerus fractures using the minimally invasive anterolateral delta split approach. Oper Orthop Traumatol. 2012;24:61–73.CrossRefPubMed Acklin YP, Sommer C. Plate fixation of proximal humerus fractures using the minimally invasive anterolateral delta split approach. Oper Orthop Traumatol. 2012;24:61–73.CrossRefPubMed
9.
go back to reference Richards RH, Palmer JD, Clarke NM. Observations on removal of metal implants. Injury. 1992;23:25–8.CrossRefPubMed Richards RH, Palmer JD, Clarke NM. Observations on removal of metal implants. Injury. 1992;23:25–8.CrossRefPubMed
10.
go back to reference Gupta AK, Harris JD, Erickson BJ, Abrams GD, Bruce B, McCormick F, Nicholson GP, Romeo AA. Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma. 2015;29:54–9.CrossRefPubMed Gupta AK, Harris JD, Erickson BJ, Abrams GD, Bruce B, McCormick F, Nicholson GP, Romeo AA. Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma. 2015;29:54–9.CrossRefPubMed
11.
go back to reference Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011;20:747–55.CrossRefPubMed Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011;20:747–55.CrossRefPubMed
12.
go back to reference Lovald S, Mercer D, Hanson J, Cowgill I, Erdman M, Robinson P, Diamond B. Complications and hardware removal after open reduction and internal fixation of humeral fractures. J Trauma. 2011;70:1273–7. discussion 1277-1278.CrossRefPubMed Lovald S, Mercer D, Hanson J, Cowgill I, Erdman M, Robinson P, Diamond B. Complications and hardware removal after open reduction and internal fixation of humeral fractures. J Trauma. 2011;70:1273–7. discussion 1277-1278.CrossRefPubMed
13.
go back to reference Visser CP, Coene LN, Brand R, Tavy DL. Nerve lesions in proximal humeral fractures. J Shoulder Elbow Surg. 2001;10:421–7.CrossRefPubMed Visser CP, Coene LN, Brand R, Tavy DL. Nerve lesions in proximal humeral fractures. J Shoulder Elbow Surg. 2001;10:421–7.CrossRefPubMed
14.
go back to reference Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg. 1995;77:296–8. Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg. 1995;77:296–8.
15.
go back to reference Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8:296–9.CrossRefPubMed Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8:296–9.CrossRefPubMed
17.
go back to reference Schwarz N, Euler S, Schlittler M, Ulbing T, Wilhelm P, Fronhöfer G, Irnstorfer M. Technical complications during removal of locking screws from locking compression plates: a prospective multicenter study. Eur J Trauma Emerg Surg. 2013;39:339–44.CrossRefPubMed Schwarz N, Euler S, Schlittler M, Ulbing T, Wilhelm P, Fronhöfer G, Irnstorfer M. Technical complications during removal of locking screws from locking compression plates: a prospective multicenter study. Eur J Trauma Emerg Surg. 2013;39:339–44.CrossRefPubMed
Metadata
Title
Elective implant removal in symptomatic patients after internal fixation of proximal humerus fractures improves clinical outcome
Authors
Yves P. Acklin
Christian Michelitsch
Christoph Sommer
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-0977-z

Other articles of this Issue 1/2016

BMC Musculoskeletal Disorders 1/2016 Go to the issue