COMPLICATIONS OF LOCKING PLATE FIXATION OF PROXIMAL HUMERUS FRACTURES: A RETROSPECTIVE SERIES OF 16 CASES AND REVIEW OF THE LITERATURE

Introduction: Locking plate fixation is widely used for displaced proximal humerus fractures. It offers stable fixation and allows early mobilisation, but complications remain frequent. The aim of this study was to describe the complications observed after locking plate fixation in our department and to discuss their mechanisms and prevention.
Materials and Methods: We conducted a retrospective study in the Department of Traumatology and Orthopaedics A, Hassan II University Hospital, Fez, from December 2016 to January 2024. Among all patients treated with a locking plate for a proximal humerus fracture, those who presented a complication were included and analysed.
Results: Of 78 patients treated with a locking plate during the study period, 16 (20.5%) presented at least one complication, with a total of 19 complications. Varus collapse of the humeral head was the most frequent (n = 6), followed by adhesive capsulitis (n = 4), intra-articular screw penetration (n = 3), avascular necrosis of the humeral head (n = 3), nonunion (n = 2) and infection (n = 1). In the cases of mechanical failure, the absence of an inferomedial calcar screw was the main technical error identified.
Conclusion: Most complications of locking plate fixation are mechanical and related to a loss of medial support. Correct plate height, restoration of the medial calcar and a well-placed calcar screw are key to prevention. In young patients with complex fractures, augmentation techniques may help; in elderly patients, arthroplasty should be considered.