Outcome analysis following removal of locking plate fixation of the proximal humerus

Background: Concerning surgical management experience with locking
plates for proximal humeral fractures has been described with
promising results. Though, distinct hardware related complaints
after fracture union are reported. Information concerning the
outcome after removal of hardware from the proximal humerus is
lacking and most studies on hardware removal are focused on the
lower extremity. Therefore the aim of this study was to analyze the
functional short-term outcome following removal of locking plate
fixation of the proximal humerus. Methods: Patients undergoing
removal of a locking plate of the proximal humerus were
prospectively followed. Patients were subdivided into the following
groups: Group HI: symptoms of hardware related subacromial
impingement, Group RD: persisting rotation deficit, Group RQ:
patients with request for a hardware removal. The clinical
(Constant-Murley score) and radiologic (AP and axial view)
follow-up took place three and six months after the operation. To
evaluate subjective results, the Medical Outcomes Study Short
Form-36 (SF-36), was completed. Results: 59 patients were included.
The mean length of time with the hardware in place was 15.2 +/-
3.81 months. The mean of the adjusted overall Constant score before
hardware removal was 66.2 +/- 25.2% and increased significantly to
73.1 +/- 22.5% after 3 months; and to 84.3 +/- 20.6% after 6 months
(p < 0.001). The mean of preoperative pain on the VAS-scale
before hardware removal was 5.2 +/- 2.9, after 6 months pain in all
groups decreased significantly (p < 0.001). The SF-36 physical
component score revealed a significant overall improvement in both
genders (p < 0.001) at six months. Conclusion: A significant
improvement of clinical outcome following removal was found.
However, a general recommendation for hardware removal is not
justified, as the risk of an anew surgical and anesthetic procedure
with all possible complications has to be carefully taken into
account. However, for patients with distinct symptoms it might be
justified.