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Table 5 Detailed list of categorised definitions for bone/fracture and implant/surgery complications located at the proximal humerus

From: Does osteoporosis increase complication risk in surgical fracture treatment? A protocol combining new endpoints for two prospective multicentre open cohort studies

(Secondary) Loss of reduction
= secondary fragment displacement
= redisplacement
Significant change of head position against shaft or fragment dislocation compared to the immediate postoperative position
= secondary dislocation of greater tuberosity Relative change of greater tuberosity compared to the immediate postoperative position
Malunion Fracture healed with deformity and bone unites in abnormal position and/or alignment (e.g. varus/valgus, rotational malunion)
  1. as a consequence of loss of reduction
  2. as a consequence of inadequate/insufficient anatomical reduction as observed on postoperative X-rays.
Delayed healing Insufficient signs of bridging/continuous fracture line still visible up to 6 months
Nonunion Indiscernible signs of bridging/continuous fracture line still visible after 6 months
Head impaction
= secondary fracture impaction
Secondary impaction/sintering of the head fragment with consecutive intraarticular screw penetration due to mechanical failure (not due to avascular collapse of the head fragment) compared to immediate postoperative position
Head necrosis In situ death of bone within the humeral head due to disruption of blood supply, leading to partial or complete collapse of the head
= secondary fracture at the same site
After fracture is healed: refracture occurs at the same humeral site with a load level otherwise tolerated by normal bone after the bone has solidly bridged
Functional deficit As assessed with the functional scores of DASH, SPADI, ROM and Constant-Murley
Primary malpositioning of plate Failure to fix each fragment and/or failure to implant plate according to technical guide [18] (including anatomical reduction and plate positioning i.e. at least 8 mm distal to the upper end of the greater tubercle) during operation
Primary malpositioning of screw Screw perforation into glenohumeral joint during operation
Secondary screw loosening: back-out Relative change outwards of screw position in relation to postoperative position
Secondary screw loosening: perforation Perforation of one screw through the cortex of the head (no initial perforation)
Implant loosening
= Proximal screw and plate pull out
= Distal screw and plate pull out
Multiple proximal or distal screw loosening leading to firstly, relative movement between one main fragment and the plate and secondly, pull-out of the implant
Implant failure/breakage Plate/screw breakage
  1. DASH = Disabilities of the Arm, Shoulder and Hand questionnaire SPADI = Shoulder Pain And Disability Index ROM = Range Of Motion