Functional outcomes and complications after locked plating of fracture-dislocations of the proximal humerus and the significance of the intertuberosity periosteal bridge

We aimed to evaluate the functional outcomes and complications following locked plating of three- or four-part proximal humerus fracture-dislocations (PHFDs). We evaluated the functional outcomes and range of motion (ROM) deficit of 26 shoulders with PHFD (AO/OTA 11B1.1(5a), 11B1.1(5b), 11B1.2(5b), 11C3.1(5a), 11C3.1(5b), 11C3.2(5a)), in 25 patients after locking plate fixation. Three patients with avascular necrosis (AVN) of humeral head were followed for one year, and the remaining 22 patients were followed for 24-89 months. At the most recent follow-up, the shoulder subjective value was 77 (60-85), the normalized Constant score was 70 (53-83), the visual analogue scale pain scores were 1 (0-2), the elevation ROM deficit was 35° (13-41), the external rotation ROM deficit was 20° (10-33), and internal rotation ROM (number of vertebrae) deficit was 4 (1-6). AVN was noted in six (23%) shoulders; the shoulders with AVN had worse outcomes than those without AVN. Absent capsular attachments (p < .001), an opened intertuberosity periosteum, and a four-part fracture configuration (p = .004) were significantly associated with AVN. To conclude, functional outcomes after locked plating of fracture-dislocations were acceptable in the majority of the patients. However, complications such as AVN may occur in 23% of patients, leading to poor outcomes. Level 4; case series.