Primary screw perforation or subsequent screw cut-out following proximal humerus fracture fixation using locking plates: a review of causative factors and proposed solutions

• Published in: International orthopaedics Vol. 42; no. 8; pp. 1935 - 1942
• Main Authors: McMillan, Tristan E., Johnstone, Alan J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2018
• Subjects: Bone Plates - adverse effects; Bone Screws - adverse effects; Fracture Fixation - adverse effects; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Humans; Incidence; Medicine; Medicine & Public Health; Orthopedics; Postoperative Complications - etiology; Review Article; Risk Factors; Shoulder Fractures - surgery; Treatment Outcome; Locking plate fixation; Fixation failure; Osteoporosis; Screw perforation; Proximal humerus fracture
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-017-3652-6

The surgical treatment of proximal humerus fractures remains controversial primarily due to the high complication rate associated with the available fixation methods. In an attempt to reduce the incidence of serious complications and subsequent poor clinical outcomes, proximal humerus locking plates have become popular but even these implants cannot overcome the risk of complications, especially those associated with loss of fracture reduction and screw cut-out/migration through the humeral head. In an attempt to address these issues, we have reviewed the literature, investigating the most likely causes for these predominantly mechanical complications and propose technical solutions.