{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:23:42Z","timestamp":1781843022570,"version":"3.54.5"},"reference-count":69,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T00:00:00Z","timestamp":1675382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This prospective cohort study included 50 patients with a mean age of 63.2 (range 28\u201392) years treated by one single surgeon using a previously published standardized surgical protocol. Clinical and radiological follow-up examinations were conducted for up to 24 months using Constant\u2013Murley Score (CS), Subjective Shoulder Value (SSV) and radiographs in true anteroposterior, axial and y-view. Finally, CS was 73.9 (standard deviation [SD]: 14.0) points (89% compared to the uninjured shoulder), and SSV was 83.3% (SD: 16.7) at two years of follow-up. Postoperative radiologic evaluation revealed no primary surgical-related or soft-tissue-related complications (0%). The main complications were secondary, biological complications (20%), largely represented by avascular necrosis (8%). Eight patients underwent revision surgery, mainly for implant removal. In addition, a total of four patients were revised using a hemiarthroplasty (n = 2), reverse shoulder arthroplasty (n = 1) or re-osteosynthesis. The use of our standardized surgical technique on proximal humerus fractures improves fixation with regard to primary stability and prevents primary, surgical-technique-related complications. The subjective grading of a high level of difficulty surgery was associated with more complications.<\/jats:p>","DOI":"10.3390\/jcm12031216","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T01:40:25Z","timestamp":1675388425000},"page":"1216","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications"],"prefix":"10.3390","volume":"12","author":[{"given":"Sebastian","family":"Kwisda","sequence":"first","affiliation":[{"name":"Department of Shoulder and Elbow Surgery, Schulthess Clinic, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Philipp","family":"Imiolczyk","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9-Universitaetsmedizin Berlin, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tankred","family":"Imiolczyk","sequence":"additional","affiliation":[{"name":"Department of Mathematics, University of Mannheim, 68131 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Werth","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9-Universitaetsmedizin Berlin, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Scheibel","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9-Universitaetsmedizin Berlin, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S209","DOI":"10.1016\/8756-3282(95)00504-8","article-title":"The epidemiology of peripheral fractures","volume":"18","author":"Baron","year":"1996","journal-title":"Bone"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: A review","volume":"37","author":"Caesar","year":"2006","journal-title":"Injury"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jse.2007.03.016","article-title":"Proximal humeral fractures: A systematic review of treatment modalities","volume":"17","author":"Lanting","year":"2008","journal-title":"J. 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