Evidence map›Paper›PMID 39280154›Full record

ArticleJSES international2024

Patient satisfaction after removal of locking plates in proximal humeral fractures - worth the surgery under functional and cosmetic aspects?

Ludwig Jägerhuber, Georg Siebenbürger, Evi Fleischhacker, Fabian Gibert, Wolfgang Böcker, Tobias Helfen

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Article in JSES international, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Ludwig JägerhuberDepartment of Orthopaedics and Trauma Surgery, LMU University Hospital, LMU Munich, Germany.
Georg SiebenbürgerDepartment of Orthopaedics and Trauma Surgery, LMU University Hospital, LMU Munich, Germany.
Evi FleischhackerDepartment of Orthopaedics and Trauma Surgery, LMU University Hospital, LMU Munich, Germany.
Fabian GibertDepartment of Orthopaedics and Trauma Surgery, LMU University Hospital, LMU Munich, Germany.
Wolfgang BöckerDepartment of Orthopaedics and Trauma Surgery, LMU University Hospital, LMU Munich, Germany.
Tobias HelfenDepartment of Orthopaedics and Trauma Surgery, LMU University Hospital, LMU Munich, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Locking plates are one of the most frequently used implants in surgical treatment of displaced proximal humeral fractures. In spite of this established implant and a standardized approach, reduced shoulder function might remain a mid-to long-term issue, furthermore scars may influence patient satisfaction as a cosmetic issue. Indications for a second surgery to remove implant and/or scar revision are common questions in this context.The aim of the present study was to assess the benefit of a second surgery, including implant removal and scar revision surgery, on patients' satisfaction under functional and cosmetic aspects. Methods: Patients following displaced proximal humeral fractures treated by open reduction and internal fixation with a locking plate osteosynthesis via a delto-pectoral approach following implant removal were included retrospectively. A follow-up took place anamnestically before the incident or the primary surgery [A], before second surgery [B], and after second surgery (scar revision/implant removal) [C]. Functional outcome (Constant Score (CS)) of both shoulders was obtained using a patient-reported outcome measure to evaluate the contralateral side as well as percentage CS (%CS). Furthermore, the cosmetic outcome was evaluated for color, contour, and size. Results: The clinical data of n = 81 patients with displaced proximal humeral fractures and the consecutive open reduction and internal fixation with a locking plate (51 women = 63.0% and 30 men = 37.0%; mean age: 53.7 ± 16.6 years) via a standardized deltopectoral approach could be included. The mean CS) before sustaining the humeral fracture or primary surgery [A] was anamnestically 85.8 ± 8.5 points and %CS 99.4 ± 8.4%. After open reduction and internal with a locking plate osteosynthesis [B], the mean CS was 72.2 ± 9.1 points and %CS 84.5 ± 8.7%. Following the scheduled implant removal and scar revision [C], the CS was 80 ± 13.1 points and %CS 92.3 ± 14.1%. After primary surgery, 26 patients (32.1%) complained about the scar because of color, contour, or size before the second surgery, and 23 patients (28.4%) afterwards. Conclusion: Implant removal after locking plate osteosynthesis in proximal humeral fractures via a delto-pectoral approach leads to an improved outcome both functionally and cosmetically. CS as well as scar situation and patients' overall satisfaction could be improved with a second surgery. Nevertheless, the need for a second surgery depends on the patients' functional and cosmetic demands.

Indexed as

Constant ScoreCosmeticsFunctional outcomeImplant removalLocked platingProximal humeral fractureScar

Identifiers

PMID39280154
PMCPMC11401535

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