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Detection of primary screw perforation in locking plate osteosynthesis of proximal humerus fracture by intra-operative 3D fluoroscopy

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to identify the rate of primary screw perforations after osteosynthesis of proximal humerus fractures with intra-operative 3D fluoroscopy and to analyse the rate of secondary screw perforations as well as complications, outcome, and revision surgeries after a minimum of 12 months.

Materials and methods

Thirty-three patients (20 female, 13 male, median age 67 years, range 35–85 years) with displaced proximal humerus fractures were included. After reduction and fixation, an intra-operative 3D fluoroscopy was performed to evaluate primary screw perforations (PS) and screws with “near perforation” (nPS). These screws were changed intra-operatively. Patients were followed-up for a minimum of 12 months. Clinical and radiological parameters, such as secondary screw perforation, secondary loss of reduction, or functional outcome, were investigated.

Results

In six patients (18.2%), humeral head screws were changed due to primary PS (n = 2) or nPS (n = 4) after the intra-operative 3D fluoroscopy. Follow-up revealed an adapted constant score (%CMS) of 76.2% after a mean follow-up of 17.7 months. Two secondary screw perforations were observed (6%). Loss of reduction was observed in eight patients (24.2%).

Conclusion

The intra-operative 3D reveals a high rate of primary screw perforations or near perforations. Immediate change of these screws may lead to a lower rate of secondary screw perforations and, therefore, reduce post-operative complications.

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Authors and Affiliations

  1. Department of Orthopaedics, Trauma and Plastic Surgery, Division of Arthroscopy, Joint Surgery and Sport Injuries, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

    Jan Theopold, Kevin Weihs, Bastian Marquaß, Christoph Josten & Pierre Hepp

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  1. Jan Theopold
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  2. Kevin Weihs
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  3. Bastian Marquaß
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  4. Christoph Josten
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  5. Pierre Hepp
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Correspondence to Pierre Hepp.

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The authors declare that they have no conflict of interest.

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There is no funding source.

Ethical approval

This study was approved by the local institutional review board (Ref.: 312-15-24082015).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

All authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

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Theopold, J., Weihs, K., Marquaß, B. et al. Detection of primary screw perforation in locking plate osteosynthesis of proximal humerus fracture by intra-operative 3D fluoroscopy. Arch Orthop Trauma Surg 137, 1491–1498 (2017). https://doi.org/10.1007/s00402-017-2763-2

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  • DOI: https://doi.org/10.1007/s00402-017-2763-2

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