A Comparison of Clinical Outcomes in Proximal Humerus Fractures Treated With Single- And Dual-Plating Constructs

Failure of proximal humeral fracture fixation remains unacceptably common with up to a 15% reoperation rate reported in the literature. Dual plating is an emerging technique to provide additional fixation, addressing many of the mechanical etiologies of failure. While biomechanical studies and case series support this fixation strategy, literature comparing single- and dual-plated constructs is limited. We retrospectively sampled patients receiving internal fixation for proximal humeral fractures at our institution from 2010 to the present day (n=145). Exclusion criteria included non-acute fractures, isolated greater tuberosity fractures, pathologic fractures, head split. Patients were grouped based on whether they were treated with a single precontoured locking plate or with supplemental plate fixation added. Main outcome measures were reoperations, complications and radiographic outcomes. We identified a sample of 145 patients, 88 treated with single-plating (mean age 54.1, 45.5% female, mean follow up 12.3 months) and 57 treated with dual-plating (mean age 54.6, 54.4% female, mean follow up 10.1 months). The rate of any complication and reoperation, respectively, in the single-plating group was 40.9% and 19.3%, and in the dual-plating group was 15.8% (p = 0.001) and 3.5% (p = 0.006). The most common reoperation types were revision internal fixation (n = 10) and hemiarthroplasty (n = 5). After modelling to control for age, sex, bone quality and high energy mechanism, dual-plate fixation was associated with 10-fold decrease in reoperation (OR = 0.099, p = 0.029). In patients with proximal humerus fractures treated with operative fixation at our institution, dual-plate constructs resulted in a lower rate of complications and reoperations compared to single-plate constructs. Multi-center cohorts are needed to further develop our findings.