Early locking plate removal following open reduction and internal fixation of proximal humeral fractures could prevent secondary implant-related complications

Abstract

Introduction: Proximal humeral fracture is a common cause of morbidity in the elderly and poses a challenge for the orthopedic surgeon. Open reduction and internal fixation (ORIF) with a locking plate is associated with high rate of secondary implant-related complications (IRC). Early implant removal could potentially reduce the risk of IRC and further improve the outcome in relatively asymptomatic patients. The purpose of this study was to evaluate the clinical and radiologic outcomes following implant removal. Methods: A total of 56 patients with an average age of 63 ± 13 years and a mean follow-up of 29 months were evaluated retrospectively following removal of a locking plate in the proximal humerus. Postoperative functional outcomes were evaluated with the Constant-Score, Subjective shoulder value and Quick-DASH score. Results: Early implant removal resulted in high functional outcomes with 96% of the patients reporting an improvement of their shoulder function following implant removal. No intraoperative complications were reported. Avascular necrosis (AVN) of the humeral head occurred in 12.5% of the patients, but no secondary screw cut-out was reported. Conclusion: Early implant removal might be a safe option to avoid secondary IRC with significant subjective functional improvement also in asymptomatic patients. Although early implant removal cannot reverse the process of AVN, it could potentially prevent secondary IRC and subsequent glenohumeral cartilage destruction.

Elective removal vs. retaining of hardware after osteosynthesis in asymptomatic patients – A scoping review.

“…Clinical outcomes, like range of motion, were reported in six studies. (23,24,30,(33)(34)(35) For the cohort studies and one before-after study, there was no difference in the outcomes, (23,24,35) while the other three before-after studies showed advanced range of motion. (30,33,34) Garner et al measured two components of the Short Form 36 scale for quality of life, with better outcomes for physical components in the removal group.…”

“…The literature search identi ed 13 eligible studies.) (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) The studies were conducted in Germany, (26)(27)(28) the USA, (29,30,32,33) Switzerland, (22,34) Singapore, (23) New Zealand,(24) the UK, (31) and Japan. (35) Moreover we identi ed a protocol on an ongoing RCT regarding syndesmotic screw removal conducted in the Netherlands (36) and an entry on clinicaltrials.gov about an RCT regarding removal/retaining material in Lisfranc fractures conducted in Canada.…”

“…(26,29,31) Furthermore we identi ed eight before-after studies, comparing the same patients before implant removal and after implant removal. (22,27,28,30,(32)(33)(34)(35)…”

“…(36) Three studies were conducted in Germany, (26)(27)(28) four in the USA. (29,30,32,35) The other studies were conducted in Switzerland, (22,34) Singapore,(23) New Zealand, (24)the UK (31) and Japan. (35) The ongoing RCTs will be performed in the Netherlands and Canada.…”

“…(35) The ongoing RCTs will be performed in the Netherlands and Canada. (25) There are six studies examining the removal of syndesmotic screws (23-25, 29-31, 33), two studies on plate removal from the proximal humerus, (22,34) two studies on plate removal in the tibia, (26,35) and one study on nail removal in the tibia (27) and nail removal in the femur. (28) Chu et al included diverse indications treated with different materials.…”