Open reduction and plate internal fixation (ORIF) is one of the most common treatment methods for proximal humeral fractures. Complications associated with the greater tuberosity (GT) are rarely reported, therefore, the purpose of this study was to analyze the complications associated with the GT and the risk factors after locked-plate internal fixation. We retrospectively analyzed the medical and radiographic data of patients with proximal humeral fractures involving the GT treated with locking plates between January 2016 and July 2019. We divided all patients into two groups, the anatomic GT healing group and the nonanatomic GT healing group, depending on the radiographic outcomes of the GT. Clinical outcome was assessed by the Constant scoring system. Potential risk factors included preoperative and intraoperative factors. Preoperative factors included sex, age, body mass index, fracture type, fracture-dislocation, proximal humeral bone mineral density, humeral head extension, hinge integrity, comminuted GT, volume and surface area of the main GT fragment, and displacement of the main GT fragment. Intraoperative factors were adequate medial support, residual head-shaft displacement, head-shaft angle and residual GT displacement. Univariate logistic regression and multivariate logistic regression were used to identify risk factors. There were 207 patients (130 women and 77 men; mean age, 55 years). GT anatomic healing was observed in 139 (67.1%) patients and nonanatomic healing in 68 (32.9%). Patients with GT nonanatomic healing had significantly inferior Constant scores than those with GT anatomic healing (75.0 ± 13.9 vs. 83.9 ± 11.8, P < 0.001). Patients with high GT malposition had worse Constant scores than patients with low GT malposition (73.3 ± 12.7 vs. 81.1 ± 11.4, P = 0.039). The multivariate logistic model showed that GT fracture characteristics were not risk factors for nonanatomic GT healing, while residual GT displacement was. Nonanatomic healing of the GT is a high-rate complication of proximal humeral fractures, resulting in inferior clinical outcomes, especially for high GT malposition. Fracture characteristics of the GT are not risk factors for GT nonanatomic healing and GT comminution should not be regarded as a contraindication to ORIF for proximal humeral fractures.

中文翻译：

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肱骨近端骨折钢板固定后大结节的非解剖愈合：病例对照研究

切开复位钢板内固定术（ORIF）是肱骨近端骨折最常用的治疗方法之一。大结节(greater tuberosity, GT)相关并发症鲜有报道，因此，本研究旨在分析锁定钢板内固定术后GT相关并发症及危险因素。我们回顾性分析了 2016 年 1 月至 2019 年 7 月期间接受锁定钢板治疗的涉及 GT 的肱骨近端骨折患者的医学和影像学数据。我们将所有患者分为两组，解剖性 GT 愈合组和非解剖性 GT 愈合组，这取决于GT 的放射学结果。通过 Constant 评分系统评估临床结果。潜在危险因素包括术前和术中因素。术前因素包括性别、年龄、体重指数、骨折类型、骨折脱位、肱骨近端骨密度、肱骨头伸展、铰链完整性、粉碎的 GT、主要 GT 碎片的体积和表面积以及主要 GT 的移位分段。术中因素包括足够的内侧支撑、残余头轴位移、头轴角度和残余 GT 位移。单变量逻辑回归和多变量逻辑回归用于识别危险因素。共有 207 名患者（130 名女性和 77 名男性；平均年龄 55 岁）。在 139 名 (67.1%) 患者中观察到 GT 解剖愈合，在 68 名 (32.9%) 患者中观察到非解剖愈合。GT 非解剖愈合患者的 Constant 评分明显低于 GT 解剖愈合患者（75.0 ± 13.9 对 83.9 ± 11.8，P < 0.001）。高 GT 错位患者的 Constant 评分比低 GT 错位患者差（73.3 ± 12.7 对 81.1 ± 11.4，P = 0.039）。多变量逻辑模型显示 GT 骨折特征不是非解剖性 GT 愈合的危险因素，而残余 GT 移位是。GT 的非解剖愈合是肱骨近端骨折的高发并发症，导致较差的临床结果，特别是对于高 GT 错位。GT 的骨折特征不是 GT 非解剖愈合的危险因素，GT 粉碎不应被视为 ORIF 治疗肱骨近端骨折的禁忌症。多变量逻辑模型显示 GT 骨折特征不是非解剖性 GT 愈合的危险因素，而残余 GT 移位是。GT 的非解剖愈合是肱骨近端骨折的高发并发症，导致较差的临床结果，特别是对于高 GT 错位。GT 的骨折特征不是 GT 非解剖愈合的危险因素，GT 粉碎不应被视为 ORIF 治疗肱骨近端骨折的禁忌症。多变量逻辑模型显示 GT 骨折特征不是非解剖性 GT 愈合的危险因素，而残余 GT 移位是。GT 的非解剖愈合是肱骨近端骨折的高发并发症，导致较差的临床结果，特别是对于高 GT 错位。GT 的骨折特征不是 GT 非解剖愈合的危险因素，GT 粉碎不应被视为 ORIF 治疗肱骨近端骨折的禁忌症。