Complications after ORIF of proximal humerus fractures-how to deal with them

Abstract

The introduction of fixed angle locking plates increased the frequency and reliability of fixation of proximal humerus fractures (PHFs). Failure rates, however, remain high, particularly in elderly patients with complex and severe PHFs. Appropriate patient selection, a principle-based surgical technique, and conservative postoperative restrictions can help minimize failures. In the setting of failure, a thorough workup is needed to evaluate causes of failure and treatment options. This includes patient history, physical exam, plain film radiographs, CT scans, and in some cases further advanced testing (EMG and/or aspiration). Obtaining outside operative reports can help clarify decision making of previous surgeons. Special attention needs to be paid to axillary nerve function, bone loss, rotator cuff function, and infection. Issues with any of these will define management options. In young patients with preserved bone stock and humeral head anatomy, revision open reduction, internal fixation can be contemplated. In select young patients with an intact rotator cuff, hemiarthroplasty may be a viable option. For the majority of patients, revision to reverse total shoulder arthroplasty (rTSA) will be the most reliable treatment option. Ensuring appropriate component position, as well as healing of the tuberosities will improve functional outcomes and decrease complications of rTSA. In very rare cases, fusion may be needed.