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The potential of locking plate with intramedullary fibular allograft to manage proximal humeral fracture with an unstable medial column

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the potential of locking compression plate with intramedullary fibular allograft in managing proximal humeral fractures with an unstable medial column.

Methods

Between March 2007 and March 2015, we retrospectively analyzed 63 patients who underwent locking plate fixation for proximal humeral fracture with an unstable medial column. All patients were assigned into group 1 (patients treated with locking plate) and group 2 (patients treated with locking plate with intramedullary fibular allograft). Groups 1 and 2 were composed of 29 and 34 patients, respectively. We analyzed bone union, the neck–shaft angle, the Constant score, the range of motion, and complications.

Results

The mean average bone union time of the patients was 13.9 weeks in group 1 and 11.3 weeks in group 2. The average Constant score was 67.4 in group 1 and 73.6 in group 2 (p < 0.05). The mean preoperative NSA, postoperative NSA, and NSA at the last follow-up were 104.4°, 125.8°, and 115.8°, respectively, in group 1, and 109.0°, 130.3°, and 127.1°, respectively, in group 2. The mean forward flexion, abduction, external rotation, and internal rotation were 109.0°, 48.2°, 34.0°, and L5, respectively, in group 1, and 127.5°, 118.2°, 38.7°, and L1, respectively, in group 2. In group 1, avascular necrosis occurred in one patient and screw cutout in two patients. In group 2, screw cutout occurred in one patient.

Conclusion

In patients aged over 65 years with proximal humeral fractures, an unstable medial column was associated with poor clinical results owing to varus collapse. To prevent this, an intramedullary fibular allograft was used, and radiologic and clinical results were better with this approach than with a locking plate alone. Therefore, locking plate fixation using a fibular allograft is one of the possible treatments for patients with an unstable medial column.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Gil Medical Center, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea

    Young-Kyu Kim & Kyu-Hak Jung

  2. Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Republic of Korea

    Suk-Woong Kang & Young-Kwang Oh

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Correspondence to Suk-Woong Kang.

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Statement of location: Investigation performed at the Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Republic of Korea.

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Kim, YK., Kang, SW., Jung, KH. et al. The potential of locking plate with intramedullary fibular allograft to manage proximal humeral fracture with an unstable medial column. Arch Orthop Trauma Surg 142, 91–97 (2022). https://doi.org/10.1007/s00402-020-03604-2

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  • DOI: https://doi.org/10.1007/s00402-020-03604-2

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