Proximal Humerus Fracture

Abstract

Open reduction and internal fixation with locking compression plates is the most widely performed procedure in the treatment of proximal humeral fractures in elderly because of allowing for high primary stability in the osteoporotic bone (Tepass et al. 2013). The fixed-angle construct could improve the fracture stability and increase the resistance to pullout through the bone-plate interface with a single beam construct, especially useful in poor-quality cancellous bone of the proximal humerus. However, moderate and poor results still reported in approximately one-third of the patients because of loss of fixation leading to secondary complications (Biermann et al. 2019). High complication rates of up to 49% in proximal humeral fractures patients by using locking plating method have been reported, and the most two common complications are varus malunion and screw perforation (Sproul et al. 2011a). One study showed that the osteoporotic proximal humeral fracture was similar to the breakage of eggshell, and the contents in humeral head were nearly empty (Hertel 2005). Studies have also revealed the important role of medial cortex integrity and reconstruction in the shoulder-preserving treatment of proximal humeral fractures with locking plate especially in the elderly patients and medial support augmentation of plate osteosynthesis came to the existence (Gardner et al. 2007). Many efforts have been made to achieve medial support augmentation, such as medial support screws (Osterhoff et al. 2011), cement augmentation (Somasundaram et al. 2013), additional medial plate (He et al. 2015), and bone autograft (Gerber et al. 1990; Zhu et al. 2014). These treatments have partly decreased the complication rates, but meanwhile caused other problems, including humeral head necrosis (Osterhoff et al. 2011), cement-related heat injuries (Schliemann et al. 2015), neurovascular injuries (He et al. 2015), and donor-site morbidity (Heary et al. 2002).