Risk factors and complications in surgical management of proximal humeral fractures: a retrospective analysis of 132 cases.

Abstract

Proximal humeral fractures (PHF), ranking as the third most common osteoporotic fractures, pose a significant challenge in management. With a rising incidence in an aging population, controversy surrounds surgical versus nonoperative treatments, particularly for displaced 3- and 4-part fractures in older patients. Locking plates (LP) and proximal intramedullary nails (PHN) are primary choices for surgical intervention, but both methods entail complications. This retrospective study of 132 patients undergoing surgery for PHF (LP or PHN) aims to identify risk factors for postoperative complications. Results reveal a 31% complication rate, including secondary loss of reduction (17%) and intra-articular screw penetration (13%). Alcohol abuse emerges as the sole patient characteristic linked to complications. Non-anatomical surgical reduction, calcar comminution, and humeral shaft displacement over 10 mm also contribute to increased risks. LP and PHN show comparable complication rates, aligning with existing literature. The study underscores the pivotal role of achieving anatomical surgical reduction in minimizing complications. Surgical technique, fracture pattern, and patient characteristics significantly influence outcomes. Notably, alcohol abuse surfaces as a critical risk factor. The findings emphasize the importance of a nuanced approach to PHF management, tailoring interventions based on fracture characteristics and patient factors. Future research should explore these aspects, particularly in younger patient populations, to enrich our understanding of surgical outcomes in diverse age groups.