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Endosteal strut using a hydroxyapatite/poly-l-lactide mesh tube with a proximal humeral locking plate for the treatment of proximal humeral fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Proximal humeral fractures cause large intramedullary bone defects after humeral-head reduction. Hydroxyapatite/poly-l-lactide (HA/PLLA) materials are widely used for various fractures. However, the efficacy of endosteal strut using a HA/PLLA mesh tube (ES-HA/PLLA) with a locking plate for treating proximal humeral fractures was not reported. The purpose of this study is to examine the efficacy of ES-HA/PLLA with a proximal humeral locking plate in proximal humeral fractures.

Methods

Seventeen patients with proximal humeral fractures treated using ES-HA/PLLA with a locking plate from November 2017 to November 2021 were evaluated. The range of motion of the shoulder and postoperative complications were assessed at the final follow-up. Radiographs were evaluated to assess bone union and loss of reduction by measuring humeral-head height (HHH) and humeral neck-shaft angle (NSA).

Results

The average flexion and external rotation of the shoulder at the final follow-up were 137° (range, 90–180°) and 39° (range, − 10 to 60°), respectively. All fractures were united. The average HHH and NSA just after the surgery and final follow-up were 12.5 mm and 11.6 mm and 129.9° and 127.4°, respectively. Two patients presented screw perforation of the humeral head. One patient underwent implant removal due to infection. Avascular necrosis of the humeral head was observed in one patient with arthritis mutilans.

Conclusions

The use of ES-HA/PLLA with a proximal humeral locking plate resulted in bone union in all patients and prevented postoperative loss of reduction. ES-HA/PLLA is one of the treatment options for proximal humeral fractures.

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References

  1. Passaretti D, Candela V, Sessa P, Gumina S (2017) Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. J Shoulder Elbow Surg 26:2117–2124. https://doi.org/10.1016/j.jse.2017.05.029

    Article  PubMed  Google Scholar 

  2. Roux A, Decroocq L, El Batti S et al (2012) Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 98:715–719. https://doi.org/10.1016/j.otsr.2012.05.013

    Article  CAS  PubMed  Google Scholar 

  3. Iglesias-Rodríguez S, Domínguez-Prado DM, García-Reza A et al (2021) Epidemiology of proximal humerus fractures. J Orthop Surg Res 16:402. https://doi.org/10.1186/s13018-021-02551-x

    Article  PubMed  PubMed Central  Google Scholar 

  4. Maier D, Jaeger M, Izadpanah K et al (2014) Current concepts review proximal humeral fracture treatment in adults. J Bone Joint Surg Am 96:251–261. https://doi.org/10.2106/JBJS.L.01293

    Article  PubMed  Google Scholar 

  5. Südkamp N, Bayer J, Hepp P et al (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 91:1320–1328. https://doi.org/10.2106/JBJS.H.00006

    Article  PubMed  Google Scholar 

  6. Krappinger D, Bizzotto N, Riedmann S et al (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288. https://doi.org/10.1016/j.injury.2011.01.017

    Article  PubMed  Google Scholar 

  7. Gardner MJ, Weil Y, Barker JU et al (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21:185–191. https://doi.org/10.1097/BOT.0b013e3180333094

    Article  PubMed  Google Scholar 

  8. Knierzinger D, Crepaz-Eger U, Hengg C, Kralinger F (2020) Does cement augmentation of the screws in angular stable plating for proximal humerus fractures influence the radiological outcome: a retrospective assessment. Arch Orthop Trauma Surg 140:1413–1421. https://doi.org/10.1007/s00402-020-03362-1

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sheng N, Wang Q, Chu G et al (2021) Cancellous bone allograft is comparable to fibular strut allograft for augmentation in three- or four-part proximal humeral fractures. J Shoulder Elbow Surg 30:2065–2072. https://doi.org/10.1016/j.jse.2020.11.029

    Article  PubMed  Google Scholar 

  10. Gardner MJ, Boraiah S, Helfet DL, Lorich DG (2008) Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma 22:195–200. https://doi.org/10.1097/BOT.0b013e31815b3922

    Article  PubMed  Google Scholar 

  11. Wang H, Rui B, Lu S et al (2019) Locking plate use with or without strut support for varus displaced proximal humeral fractures in elderly patients. JBJS Open Access. https://doi.org/10.2106/JBJS.OA.18.00060

    Article  PubMed  PubMed Central  Google Scholar 

  12. Takada N, Otsuka T, Suzuki H, Yamada K (2013) Pediatric displaced fractures of the lateral condyle of the humerus treated using high strength, bioactive, bioresorbable F-u-HA/PLLA pins: A case report of 8 patients with at least 3 years of follow-up. J Orthop Trauma 27:281–284. https://doi.org/10.1097/BOT.0b013e318269ba8e

    Article  PubMed  Google Scholar 

  13. Shikinami Y, Okuno M (1999) Bioresorbable devices made of forged composites of hydroxyapatite (HA) particles and poly-l-lactide (PLLA): part I. Basic Charact Biomater 20:859–877. https://doi.org/10.1016/s0142-9612(98)00241-5

    Article  CAS  Google Scholar 

  14. Kuroyanagi G, Yoshihara H, Yamamoto N et al (2018) Treatment of lateral tibial condylar fractures using bioactive, bioresorbable forged composites of raw particulate unsintered hydroxyapatite/poly-l-lactide screws. Orthopedics 41:E365–E368. https://doi.org/10.3928/01477447-20180320-05

    Article  PubMed  Google Scholar 

  15. Sakai H, Takada N, Kuroyanagi G et al (2021) Biomechanical comparison of bioresorbable F-u-HA/PLLA screw and tension band wire fixation in medial malleolar fractures. World Acad Sci J. https://doi.org/10.3892/wasj.2021.97

    Article  Google Scholar 

  16. Usami T, Takada N, Sakai H et al (2021) Treatment of patellar fractures using bioresorbable forged composites of raw particulate unsintered hydroxyapatite/poly-l-lactide cannulated screws and nonabsorbable sutures. Injury 52:1587–1591. https://doi.org/10.1016/j.injury.2020.12.015

    Article  PubMed  Google Scholar 

  17. Meinberg EG, Agel J, Roberts CS et al (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32:S1–S170. https://doi.org/10.1097/BOT.0000000000001063

    Article  PubMed  Google Scholar 

  18. Lee SH, Han SS, Yoo BM, Kim JW (2019) Outcomes of locking plate fixation with fibular allograft augmentation for proximal humeral fractures in osteoporotic patients: comparison with locking plate fixation alone. Bone Joint J 101-B:260–265. https://doi.org/10.1302/0301-620X.101B3.BJJ-2018-0802.R1

    Article  CAS  PubMed  Google Scholar 

  19. Dasari SP, Kerzner B, Fortier LM et al (2022) Improved outcomes for proximal humerus fracture open reduction internal fixation augmented with a fibular allograft in elderly patients: a systematic review and meta-analysis. J Shoulder Elbow Surg 31:884–894. https://doi.org/10.1016/j.jse.2021.11.004

    Article  PubMed  Google Scholar 

  20. Saltzman BM, Erickson BJ, Harris JD et al (2016) Fibular strut graft augmentation for open reduction and internal fixation of proximal humerus fractures: a systematic review and the authors’ preferred surgical technique. Orthop J Sports Med. https://doi.org/10.1177/2325967116656829

    Article  PubMed  PubMed Central  Google Scholar 

  21. Russo R, D’Auria D, Ciccarelli M et al (2017) Triangular block bridge method for surgical treatment of complex proximal humeral fractures: theoretical concept, surgical technique and clinical results. Injury 48:S12–S19. https://doi.org/10.1016/S0020-1383(17)30651-4

    Article  PubMed  Google Scholar 

  22. Favorito P, Kohrs B, Donnelly D (2021) Proximal humeral fractures treated with an intramedullary cage and plate: clinical and radiographic outcomes at a minimum of 1 year postoperatively. J Shoulder Elbow Surg 30:2786–2794. https://doi.org/10.1016/j.jse.2021.05.001

    Article  PubMed  Google Scholar 

  23. Chen H, Cui X, Rui Y et al (2020) Indirect reduction and strut support of proximal humerus fractures using a titanium mesh in elderly patients: a novel technique. J Orthop Trauma 34:E142–E147. https://doi.org/10.1097/BOT.0000000000001699

    Article  PubMed  Google Scholar 

  24. Sproul RC, Iyengar JJ, Devcic Z, Feeley BT (2011) A systematic review of locking plate fixation of proximal humerus fractures. Injury 42:408–413. https://doi.org/10.1016/j.injury.2010.11.058

    Article  PubMed  Google Scholar 

  25. Panagiotopoulou VC, Varga P, Richards RG et al (2019) Late screw-related complications in locking plating of proximal humerus fractures: A systematic review. Injury 50:2176–2195. https://doi.org/10.1016/j.injury.2019.11.002

    Article  PubMed  Google Scholar 

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Funding

The present study was supported in part by a Grant-in-Aid for Scientific Research (19K18471) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Japan

    Hidetoshi Iwata, Naoya Takada & Isato Sekiya

  2. Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan

    Gen Kuroyanagi, Takuya Usami & Hideki Murakami

  3. Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, Okayama, 773-8236, Japan

    Norio Yamamoto

Authors
  1. Hidetoshi Iwata
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  2. Naoya Takada
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  3. Gen Kuroyanagi
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  4. Norio Yamamoto
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  5. Takuya Usami
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  6. Isato Sekiya
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  7. Hideki Murakami
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Contributions

HI, NT, and GK drafted the manuscript. NT, NY, TU, IS, and HM critically reviewed the manuscript. All authors have read and approved the final submitted manuscript.

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Correspondence to Gen Kuroyanagi.

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Iwata, H., Takada, N., Kuroyanagi, G. et al. Endosteal strut using a hydroxyapatite/poly-l-lactide mesh tube with a proximal humeral locking plate for the treatment of proximal humeral fractures. Eur J Orthop Surg Traumatol 34, 217–223 (2024). https://doi.org/10.1007/s00590-023-03638-3

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