Screw-tip augmentation versus standard locked plating of displaced proximal humeral fractures: a retrospective comparative cohort study

Background: This study compared the clinical and radiologic outcomes of screw tip-augmented locking plate osteosynthesis vs. standard locked plating in elderly patients with displaced proximal humeral fractures. Methods: Of the 94 patients older than 65 years with displaced proximal humeral fractures. 55 underwent fixation with a locking plate only whereas 39 underwent fixation using a locking plate with fluoroscopy-controlled polymethyl methacrylate augmentation of screw tips. Results: At 2 years' follow-up, the locking plate-only group showed a mean Constant score (CS) of 62.6 +/- 17.4 points, mean CS as a percentage of the uninjured side of 78.2% +/- 18.9%, and mean age- and sex-adjusted CS of 72.4 +/- 20.5 points. Among the 39 patients who underwent locked plating with polymethyl methacrylate augmentation of screw tips. the mean CS was 63.7 +/- 18.5 points (P = .28), the mean CS as a percentage of the uninjured side was 79.5% +/- 20.4% (P = .36), and the mean age- and sex-adjusted CS was 76.8 +/- 26.2 points (P = .11). The mean Disabilities of the Ann, Shoulder and Hand score was 26.4 +/- 21.3 in the locking plate-only group compared with 23.6 +/- 19.2 in the group with screw tip-augmented locking plate osteosynthesis (P = .41). The overall complication rate was 16.3% in the locking plate only group compared with 12.8% in the group with screw tip augmented osteosynthesis (P = .86); loss of fixation occurred in 10.9% vs. 5.1% (P = .74). The follow-up rate was 81%. Conclusions: Loss of fixation was less frequent when augmentation of screw tips was performed; however, at the 2-year follow-up, the clinical and radiologic outcomes were not significantly different compared with standard locked plating without augmentation. (C) 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.