The Impact of Learning Curve on Surgical Performance focused on Achieving Medial Support in Proximal Humeral Fracture: ORIF using locking plate for complex proximal humeral fracture

Abstract

Abstract Background: Although the optimal treatment for proximal humeral fractures has not been established yet, open reduction and internal fixation (ORIF) using a locking plate is currently recommended as a viable option. However, such procedures in some cases are technically in demand, and it is more difficult than expected for less experienced beginner surgeons. This study aimed to evaluate with respect to whether the surgical performance, focused on achieving medial support, improved during their learning periods of novice surgeons for open reduction and internal fixation (ORIF) using locking plate of complex proximal humeral fracture. Methods: This retrospective study was performed on 62 patients who underwent ORIF for complex proximal humeral fractures from three fellowship-trained shoulder specialists in same training institution, who had just started their own clinics in one of the three different institutions. Based on the periodic splitting of 2 groups between the first and subsequent 1-year during the learning curve, we assessed the achievement of medial support as a primary variable. Patient demographics, clinical outcomes, radiological outcomes including technical errors, and complications were also evaluated. Results: Group A (32 patients) in the first and group B (30 patients) in subsequent 1-year of experience were included in this study. There were no statistically significant differences between the two groups in the demographic data, the distribution of fracture type, and the presence of medial comminution at the time of the injury. The interesting finding was that significant increases in cases that were achieved the medial support (p=0.027) and adequate position of the plate (p=0.008) were seen in Group B than in Group A. However, the periodic splitting of the two groups showed no difference in the clinical results and postoperative stiffness in the final follow-up. Conclusions: The study showed that the surgical performance regarding the achievement of medial support was improved during the learning curve of the inexperienced surgeon for locking plate fixation in complex proximal humeral fracture. Its recognition as a reference for a significant learning curve effect will play a role in emphasizing the need to focus faster and safely overcome the learning curve.