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Failure of humeral shaft fixation: construct characteristics

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Fixation failure following open reduction and internal fixation (ORIF) of humeral shaft fractures can be a challenging complication. We aimed to identify the modes of failure and characteristics of failed fixation constructs.

Methods

We queried our institutional database for patients > 18 years old with fixation failure after ORIF with single plate and screw constructs of humeral shaft fractures from 2006 to 2017. Demographics, fracture characteristics, fixation construct design and mode of failure were recorded.

Results

Twenty-three failures were identified. Mean age was 55.9 years (SD 19.2 years) with 15 (65%) women. Twelve patients (52%) had midshaft fractures; the remainder had distal-third shaft (8 pts, 35%) or proximal-third shaft (3 pts, 13%) fractures. Midshaft fractures were most commonly fixed through an anterolateral approach with plates and all non-locking screws (83%), while distal-third shaft fractures were fixed with a combination of locking and non-locking screws from a posterior approach. Distal-third shaft fractures failed by plate breakage (63%) or screw pullout (38%) and all midshaft failures occurred by screw pullout proximal (92%) or distal (8%) to the fracture. Resultant varus deformity occurred in 20 (87%) fractures.

Conclusion

Screw pullout in midshaft fractures suggests that fixation to bone was insufficient or biomechanically disadvantageous. Varus moments contribute significantly to the failure of humeral shaft fracture ORIF. Plate breakage in distal fractures suggests high concentrations of stress over a narrow working length of constructs with inadequate plate strength. Recognizing how these constructs fail can aid proper implant selection and application for humeral shaft fracture.

Level of evidence

Treatment level IV.

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Funding

No financial renumeration was obtained for this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, St. Luke’s University Health Network, Bethlehem, PA, USA

    Andrew D. Sobel

  2. Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Andrew D. Sobel, Jeremy Raducha, Eva Koeller & Scott Paxton

  3. Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Andrew D. Sobel & Lina I. Ibrahim

  4. Department of Orthopedic Surgery, Scripps Clinic, San Diego, CA, USA

    Kalpit N. Shah

Authors
  1. Andrew D. Sobel
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  2. Kalpit N. Shah
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  3. Jeremy Raducha
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  4. Eva Koeller
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  5. Lina I. Ibrahim
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  6. Scott Paxton
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Corresponding author

Correspondence to Lina I. Ibrahim.

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Conflict of interest

Dr. Scott Paxton is a consultant for Miami Device Solutions, Catalyst, and Stryker. Dr. Andrew Sobel is a consultant for DuPuy-Synthes and receives research support from Medartis.

Ethical approval

This study was approved by our Institutional Review Board: Lifespan—The Miriam Hospital IRB [1143713-1].

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Not applicable.

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Sobel, A.D., Shah, K.N., Raducha, J. et al. Failure of humeral shaft fixation: construct characteristics. Eur J Orthop Surg Traumatol 33, 3637–3641 (2023). https://doi.org/10.1007/s00590-023-03587-x

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  • DOI: https://doi.org/10.1007/s00590-023-03587-x

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