This study aims to investigate the impact of screw configuration on clinical outcomes and radiographic parameters in patients with proximal humeral fractures treated with plate and screw fixation. The goal is to identify the optimal screw arrangement within the plates to enhance stability, functional recovery, and overall patient satisfaction. A retrospective cohort study was conducted on a sample of 100 patients diagnosed with proximal humeral fractures. Participants were categorized into two groups based on the screw configuration used for fixation: Group A (parallel screws, n=45) and Group B (mixed configuration, n=55). All patients received the same type of plate for fixation. Demographic data, fracture characteristics, and preoperative functional status were recorded for each participant. Surgical interventions involved plate and screw fixation. Postoperative assessments included clinical evaluations using the Constant-Murley score, radiographic analysis for fracture reduction and screw position, and complications recorded during the follow-up period. Statistical analyses were performed using independent t-tests for continuous variables and chisquare tests for categorical variables, with a significance level set at p<0.05. The comparative analysis between the two groups—Group A (parallel screw configuration) and Group B (mixed screw configuration)—demonstrated significant differences in both clinical and radiographic outcomes. Patients in Group B exhibited notably higher mean scores on the Constant-Murley scale (85.2 ± 7.1) compared to those in Group A (72.4 ± 8.9), indicating a significant enhancement in functional outcomes (p<0.001). Range of motion assessments revealed greater shoulder flexibility and movement in Group B, with statistically significant improvements across multiple planes of motion (p<0.01). Radiographic assessments indicated better screw position and fracture alignment in Group B, with fewer incidences of malalignment and intra-articular screw penetration observed in Group A. Complication rates, including nonunion and implant-related issues, were comparable across the two groups (p=0.45). The multivariate regression analysis highlights that while age and fracture type influenced outcomes in both groups, the mixed screw configuration (Group B) showed a stronger positive association with functional recovery, better fracture alignment, and more favorable Constant-Murley scores compared to the parallel configuration (Group A). The mixed screw configuration significantly enhances clinical and radiographic outcomes compared to the parallel configuration. The improved stability, reduced malalignment, and enhanced functional recovery underscore the importance of optimizing screw arrangements in plate fixation. Adopting a mixed configuration can lead to better patient outcomes, lower rates of surgical revisions, and overall increased patient satisfaction.
Davulcu et al. (Mon,) studied this question.