The Relationship Between Proximal Humeral Fracture Classification Systems And Secondary Screw Penetration

OBJECTIVES: Review all kinds of proximal humeral fracture classifications and identify which type is suitable for this research.And then to investigate the relationship between proximal humeral fracture classification systems and secondary screw penetration.METHODS: Firstly,we reviewed all publications on proximal humeral fractures and identified at least 2 kinds classification systems to be suitable for the second part of this study.Then we retrospectively identified patients with proximal humeral fractures treated by ORIF at our hospital.All fractures were classified according to the X-ray and CT scans before surgery and follow-up for least 2 years after surgery.At each follow-up,trauma series X-ray radiographs were taken to evaluate secondary screw penetration.RESULTS: After reviewing papers,we found that Neer and AO classification systems are widely accepted and known around the world.Therefore,the two were included in the following part of this study.Our clinical study enrolled 198 patients and the overall rate of secondary screw penetration was 13.8%.What is more,the risk of AO type C fractures was 18.6 fold higher that AO type A fractures(P < 0.05)and that of Neer 4-part fractures was 11.3 fold higher that 2-part fractures(P < 0.05),medial hinge comminution was another predictive factor for secondary screw penetration(P < 0.05).However,there was no significant difference between AO type A and AO type B fractures and between Neer 2-part and 3-part fractures.Besides,the Kappa value for Neer and AO systems were 0.593 and 0.610 respectively.CONCUSIONS: AO and Neer systems are still the most commonly used systems and sever types of the two systems were tend to suffer screw penetration after surgery.