Influencing factors of humeral head varus following plate internal fixation of proximal hu-meral fractures and the clinical effect of intraoperative neck-shaft angle
Objective To explore the influencing factors of humeral head varus in proximal humeral frac-tures(PHF)patients after plate internal fixation,and to investigate the clinical effect of intraoperative neck-shaft angle(NSA).Methods This retrospective study was conducted on 155 PHF patients managed in Luzhou Tradi-tional Chinese Medicine Hospital from Jan.2020 to Jan.2023.There were 88 males and 67 females aged 26-65(mean 47.1)years,with 73 road traffic injuries,58 ground-level falls,15 falls from height,and 9 others.Based on whether humeral head varus occurred,patients were divided into varus group(n=38)and non-varus group(n=117).The intraoperative humeral NSA was further analyzed,with all patients divided into another 3 groups of＜125° NSA group(n=30),125°-145° NSA group(n=110),and＞145° NSA group(n=15).Clinical data of patients were collected,including age,gender,shoulder range of motion,functional score,VAS,postoperative complications,etc.Multiple logistic regression analysis was used to identify the risk factors.Generalized linear mixed models(GLMM)and restricted cubic splines(RCS)were used to analyze the dose-response relationship between intraop-erative humeral NS A and postoperative humeral head varus.Results The injury mechanism,bone mineral density,placement of screws in the humeral talus,intraoperative humeral NS A,medial cortical bone defect,and reduction quality were independent influencing factors for postoperative humeral head varus in PHF patients(P＜0.05).The multifactor GLMM model(Model 3),after adjusting a series of indicators of age,gender,injury side,etc.,showed that the risks of postoperative humeral head varus in the＜125° and＞145° NSA groups were respectively 2.244 and 1.499 times higher than that in the 125°-145° NSA group(P＜0.05).RCS analysis results showed a non-linear dose-response relationship between intraoperative humeral NSA and postoperative humeral head varus(x2=14.178,P＜0.001).Compared with the other two groups,the 125°-145° NSA group showed the largest should range of mo-tion(forward bending and upward lifting,abduction,and outward rotation),highest functional score(pain,daily ac-tivities,range of motion,total score)and least VAS(P＜0.05),but the incidence of postoperative complications re-vealed no significant difference(P＞0.05).Conclusion Intraoperative humeral NSA is one of the independent in-fluencing factors for postoperative humeral head varus in PHF patients,which can affect the functional recovery of the shoulder joint.Clinicians should pay special attention to PHF patients with a humeral NSA＜125°,and try their best to achieve anatomical reduction to reduce the incidence of humeral head varus.
Proximal humeral fracturesNeck-shaft anglePlate internal fixationHumeral head varus
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