Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients

BACKGROUND: Multiple studies have reported an unacceptable implant-related complication rate in proximal humeral fractures treated with locking plates, particularly in older patients. Our objective was to compare the fracture fixation failure rates in elderly patients, after a dedicated technique for locking plate fixation with cement augmentation or without it. METHODS: A total of 168 open reduction and internal fixation with locking plates were performed for complex proximal humerus fractures by a single surgeon in 136 women and 32 men older than 65 years of age (average 76 years). Treatment groups included group 1 with noncemented screws (n = 90) and group 2 with cemented screws (n = 78). As per Mayo-FJD Classification, there were 74 (44%) varus posteromedial impaction, 41 (24%) algus impaction, 46 (28%) surgical neck, and 7 (4%) head dislocation injuries. A retrospective radiographic and a clinical analysis was performed. RESULTS: At a mean follow-up of 33 months, the implant failure rate was significantly lower in the cement augmentation group (1% vs. 8%, P = .03). The overall complication rate was 21% (25% group 1, 15% group 2; P = .1). Global avascular necrosis was associated with sustaining a valgus impacted fracture (P = .02 odds ratio 5.7), but not to augmentation. Partial avascular necrosis occurred only in patients treated with cemented screws (3.8%). The overall revision rate was 9% in both groups. Forward elevation was 126 ± 36 degrees and external rotation was 44 ± 19 degrees. The mean Constant score was 70 ± 15 in group 1 and 76 ± 15 in group 2 (P = .03). CONCLUSION: Cement augmentation significantly decreased the rate of implant failure. Good results are expected for most patients treated with this technique.