{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:12:55Z","timestamp":1790997175753,"version":"4.1.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>To assess the outcomes of a dual-plating fixation technique for proximal humerus fractures using a lateral locking plate and an additional anterior reduction plate, without the use of adjuvant grafts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Tertiary referral hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Selection Criteria:<\/jats:title>\n                    <jats:p>Included were adult patients with displaced proximal humerus fractures (OTA\/AO 11A-C) who underwent dual plate fixation with a lateral locking plate and supplemental anterior plate, without adjunctive grafts, between 2018 and 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n                    <jats:p>Primary outcomes were union rate and reoperations. Additional clinical outcomes included osteoarthritis, avascular necrosis (AVN), head-shaft angle, and patient-reported outcome measures assessed at a minimum of six months postoperatively, consisting of the QuickDASH and the numerical rating scale for pain (NRSP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Forty patients were included (26 female, 65%) with an average age of 60.2 years (SD 15.1, range 27\u201386). There were 35 (87.5%) OTA\/AO type 11B and 11C fractures and 5 (12.5%) with 11A fractures. Twenty-eight patients (70.0%) had 4-part fractures, 7 patients (17.5%) had 3-part fractures, and 5 patients (12.5%) had a comminuted 2-part surgical neck fractures. Thirteen (32.5%) patients had medial comminution. The average follow-up was 25.8 months (SD 20.4, range 3.2\u201373.2). All patients achieved union after the index procedure (100%). Three patients (7.5%) required reoperation with reverse total shoulder arthroplasty because of AVN, and 1 had reoperation because of infection (2.5%). In total, 97.5% healed with &lt;10 degrees loss of humeral head-shaft angle. Four patients (10.0%) showed radiologic signs of AVN resulting in articular screw penetration after fracture healing, and 6 (15.0%) had signs of osteoarthritis. The average QuickDASH score was 18.3 (SD 16.1, range 0\u201359.1) and the average numerical rating scale for pain was 1.9 (SD 2.1, range 0\u20138).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In a cohort of 40 patients with complex proximal humerus fractures (70.0% 4-part, 17.5% 3-part, 32.5% with medial comminution) treated with a lateral locking plate and an additional anterior plate without adjunctive grafts, the union rate was 100%, reoperations related to AVN occurred in 3 patients (7.5%), and patient-reported outcomes were satisfactory at a minimum of 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000003107","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T15:00:09Z","timestamp":1761318009000},"page":"161-167","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of Dual Plate Fixation Without Adjunctive Grafts in Complex Proximal Humerus Fractures"],"prefix":"10.1097","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0859-6019","authenticated-orcid":false,"given":"Alona","family":"Katzir","sequence":"first","affiliation":[{"name":"Orthopedic Trauma Service, Hospital for Special Surgery, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Jejurikar","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Service, Hospital for Special Surgery, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Bilodeau","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Service, Hospital for Special Surgery, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishabh S.","family":"Bhadouriya","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Service, Hospital for Special Surgery, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren N.","family":"Victory","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Service, Hospital for Special Surgery, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksey","family":"Dvorzhinskiy","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Service, Hospital for Special Surgery, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Ricci","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Service, Hospital for Special Surgery, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20260213","doi-asserted-by":"crossref","first-page":"2151458517750516","DOI":"10.1177\/2151458517750516","article-title":"Proximal humerus fractures: evaluation and management in the elderly patient","volume":"9","author":"Schumaier","year":"2018","journal-title":"Geriatr Orthop Surg Rehabil"},{"key":"R2-20260213","first-page":"1008","article-title":"Comparison of effective factors in loss of reduction after locking plate-screw treatment in humerus proximal fractures","volume":"28","author":"Ad\u0131yeke","year":"2022","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"R3-20260213","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.jse.2014.05.022","article-title":"Reverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly","volume":"24","author":"Ross","year":"2015","journal-title":"J Shoulder Elbow Surg"},{"key":"R4-20260213","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1016\/j.injury.2016.08.010","article-title":"Second generation locked plating for complex proximal humerus fractures in very elderly patients","volume":"47","author":"Gavaskar","year":"2016","journal-title":"Injury"},{"key":"R5-20260213","doi-asserted-by":"crossref","first-page":"2947","DOI":"10.1016\/j.injury.2021.07.041","article-title":"A nomogram for predicting reduction loss risk after locking plate fixation for proximal humeral fractures","volume":"52","author":"Wang","year":"2021","journal-title":"Injury"},{"key":"R6-20260213","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1016\/j.injury.2012.04.015","article-title":"Calcar comminution as prognostic factor of clinical outcome after locking plate fixation of proximal humeral fractures","volume":"43","author":"Osterhoff","year":"2012","journal-title":"Injury"},{"key":"R7-20260213","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.jse.2022.07.008","article-title":"Osteoporosis does not affect bone mineral density change in the proximal humerus or the functional outcome after open reduction and internal fixation of unilateral displaced 3- or 4-part fractures at 12-month follow-up","volume":"32","author":"Bue","year":"2023","journal-title":"J Shoulder Elbow Surg"},{"key":"R8-20260213","first-page":"538","article-title":"Proximal humerus and humeral shaft nonunions","volume":"21","author":"Cadet","year":"2013","journal-title":"J Am Acad Orthop Surg"},{"key":"R9-20260213","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1177\/17585732241246718","article-title":"Open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with locking plate and intramedullary allograft: a retrospective study","volume":"17","author":"Rusimov","year":"2025","journal-title":"Shoulder Elbow"},{"issue":"suppl 6","key":"R10-20260213","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.1016\/j.injury.2014.10.022","article-title":"Fractures and fracture-dislocations of the proximal humerus: a retrospective analysis of 82 cases treated with the philos locking plate","volume":"45","author":"Erasmo","year":"2014","journal-title":"Injury"},{"key":"R11-20260213","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/BOT.0b013e3180333094","article-title":"The importance of medial support in locked plating of proximal humerus fractures","volume":"21","author":"Gardner","year":"2007","journal-title":"J Orthop Trauma"},{"key":"R12-20260213","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1016\/j.jse.2017.05.003","article-title":"Defining optimal calcar screw positioning in proximal humerus fracture fixation","volume":"26","author":"Padegimas","year":"2017","journal-title":"J Shoulder Elbow Surg"},{"key":"R13-20260213","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jse.2019.06.014","article-title":"Failure to restore the calcar and locking screw cross-threading predicts varus collapse in proximal humerus fracture fixation","volume":"29","author":"Padegimas","year":"2020","journal-title":"J Shoulder Elbow Surg"},{"key":"R14-20260213","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1302\/0301-620X.102B12.BJJ-2020-0070.R1","article-title":"The neck-shaft angle is the key factor for the positioning of calcar screw when treating proximal humeral fractures with a locking plate","volume":"102-B","author":"Wang","year":"2020","journal-title":"Bone Joint J"},{"key":"R15-20260213","doi-asserted-by":"crossref","first-page":"943","DOI":"10.2106\/JBJS.H.01144","article-title":"Quantitative assessment of the vascularity of the proximal part of the humerus","volume":"92","author":"Hettrich","year":"2010","journal-title":"J Bone Jt Surg Am Vol"},{"key":"R16-20260213","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.injury.2022.11.043","article-title":"Risk factors for loss of reduction following locked plate fixation of proximal humerus fractures in older adults","volume":"54","author":"Haws","year":"2023","journal-title":"Injury"},{"key":"R17-20260213","first-page":"429","article-title":"Dual plate for comminuted proximal humerus fractures","volume":"85","author":"Choi","year":"2019","journal-title":"Acta Orthop Belg"},{"key":"R18-20260213","doi-asserted-by":"crossref","first-page":"e387","DOI":"10.1097\/BOT.0000000000002645","article-title":"Dual-plate fixation for proximal humerus fractures with unstable medial column in patients with osteoporosis","volume":"37","author":"Seok","year":"2023","journal-title":"J Orthop Trauma"},{"key":"R19-20260213","doi-asserted-by":"crossref","first-page":"696","DOI":"10.3390\/jcm12020696","article-title":"Double plating for complex proximal humeral fractures: clinical and radiological outcomes","volume":"12","author":"Michel","year":"2023","journal-title":"J Clin Med"},{"key":"R20-20260213","doi-asserted-by":"crossref","first-page":"4653","DOI":"10.1007\/s00402-022-04738-1","article-title":"Preventing varus collapse in proximal humerus fracture fixation: 90\u201390 dual plating versus endosteal fibular allograft strut","volume":"143","author":"Patel","year":"2023","journal-title":"Arch Orthop Trauma Surg"},{"key":"R21-20260213","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.2106\/00004623-197052060-00001","article-title":"Displaced proximal humeral fractures. I. Classification and evaluation","volume":"52","author":"Neer","year":"1970","journal-title":"J Bone Joint Surg Am"},{"issue":"suppl 1","key":"R22-20260213","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and dislocation classification Compendium\u20142018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma"},{"key":"R23-20260213","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/BOT.0000000000000012","article-title":"The impact of preoperative coronal plane deformity on proximal humerus fixation with endosteal augmentation","volume":"28","author":"Little","year":"2014","journal-title":"J Orthop Trauma"},{"key":"R24-20260213","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological assessment of osteo-arthrosis","volume":"16","author":"Kellgren","year":"1957","journal-title":"Ann Rheum Dis"},{"key":"R25-20260213","first-page":"1038","article-title":"Development of the QuickDASH: comparison of three item-reduction approaches","volume":"87","author":"Beaton","year":"2005","journal-title":"J Bone Jt Surg Am Vol"},{"key":"R26-20260213","doi-asserted-by":"crossref","first-page":"e1775","DOI":"10.1097\/MD.0000000000001775","article-title":"Application of additional medial plate in treatment of proximal humeral fractures with unstable medial column: a finite element study and clinical practice","volume":"94","author":"He","year":"2015","journal-title":"Medicine"},{"key":"R27-20260213","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1007\/s43465-024-01098-3","article-title":"Application of intramedullary calcar support plate and lateral locking plate in elderly patients with neer 3 and 4-Part fractures of proximal humerus through a deltoid splitting approach","volume":"58","author":"Wang","year":"2024","journal-title":"Indian J Orthop"},{"key":"R28-20260213","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jor.2024.07.017","article-title":"Bone grafting augmentation choices in complex proximal humerus fractures: a systematic review","volume":"59","author":"Etemad-Rezaie","year":"2025","journal-title":"J Orthop"},{"key":"R29-20260213","first-page":"438","article-title":"Open reduction and internal fixation of the proximal humerus with femoral head allograft augmentation \u201cthe French fry technique.\u201d","volume":"4","author":"Kamikovski","year":"2024","journal-title":"JSES Rev Rep Tech"},{"key":"R30-20260213","first-page":"e33570","article-title":"Clinical and radiological outcome of dual plating for proximal humerus fractures","volume":"15","author":"Raithatha","year":"2023","journal-title":"Cureus"},{"key":"R31-20260213","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1177\/17585732231158798","article-title":"Dual plate fixation of proximal humerus fractures: retrospective review and surgical technique","volume":"15","author":"Alqahtani","year":"2023","journal-title":"Shoulder Elbow"},{"key":"R32-20260213","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1111\/os.13601","article-title":"Short\u2010term clinical outcome of dual plate fixation in the treatment of proximal humerus fractures with calcar comminution","volume":"15","author":"Liu","year":"2023","journal-title":"Orthop Surg"},{"key":"R33-20260213","first-page":"e20.00153","article-title":"Modified use of a fibular strut in the reduction and stabilization of 2-Part osteoporotic proximal humerus fractures","volume":"4","author":"Avilucea","year":"2020","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"R34-20260213","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/BOT.0b013e31815b3922","article-title":"Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant","volume":"22","author":"Gardner","year":"2008","journal-title":"J Orthop Trauma"},{"key":"R35-20260213","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s12178-022-09818-8","article-title":"Avascular necrosis and posttraumatic arthritis after proximal humerus fracture internal fixation: evaluation and management","volume":"16","author":"Cancio-Bello","year":"2023","journal-title":"Curr Rev Musculoskelet Med"},{"key":"R36-20260213","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1016\/j.jse.2025.01.048","article-title":"Re-evaluating surgical treatment protocol for unstable proximal humerus fractures: emphasizing soft tissue preservation via minimally invasive approach over structural allograft augmentation in deltopectoral approach. A single-center retrospective study","volume":"34","author":"Chen","year":"2025","journal-title":"J Shoulder Elbow Surg"},{"key":"R37-20260213","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.injury.2015.10.001","article-title":"Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures","volume":"47","author":"Boesmueller","year":"2016","journal-title":"Injury"},{"key":"R38-20260213","first-page":"e70368","article-title":"A study examining the functional outcomes of conservative and surgical management of three- and four-part proximal humerus fractures in individuals aged over 50 years","volume":"16","author":"Manjunatha","year":"2024","journal-title":"Cureus"},{"key":"R39-20260213","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.jseint.2024.04.015","article-title":"Identifying clinically meaningful subgroups following open reduction and internal fixation for proximal humerus fractures: a risk stratification analysis for mortality and 30-day complications using machine learning","volume":"8","author":"Agarwalla","year":"2024","journal-title":"JSES Int"},{"key":"R40-20260213","first-page":"318","article-title":"Helical PHILOS plating in shaft humeral fractures with proxi-mal extension: a safe choice using an anterior approach","volume":"175","author":"Touloupakis","year":"2024","journal-title":"LA Clin Ter"}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000003107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T14:08:21Z","timestamp":1770991701000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000003107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":40,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000003107","relation":{},"ISSN":["0890-5339","1531-2291"],"issn-type":[{"value":"0890-5339","type":"print"},{"value":"1531-2291","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-10-09","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}