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Endosteal Strut Augment Reduces Complications Associated With Proximal Humeral Locking Plates

  • Symposium: Fractures of the Shoulder Girdle
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Locking-plate technology has renewed interest in plate fixation for treating proximal humerus fractures. Complications associated with these devices, including loss of reduction, screw cutout, and intra-articular penetration, are frequent. Establishing a second column of support may reduce complications and improve clinical outcome scores.

Questions/purposes

We asked whether addition of an endosteal cortical allograft strut, used as an augment to locking-plate fixation for displaced proximal humerus fractures, would reduce complications and improve clinical outcome scores.

Patients and Methods

We retrospectively reviewed the charts and radiographs of 38 patients treated by this method. All patients were evaluated with serial radiographs, as well as the Disabilities of the Arm, Shoulder, and Hand and Constant-Murley scores. There were seven two-part, 19 three-part, and 12 four-part fractures. The minimum followup was 49 weeks (average, 75 weeks; range, 49–155 weeks).

Results

No patient had intra-articular screw penetration or cutout. No patient had complete osteonecrosis, but one had partial osteonecrosis. The reduction was lost in one patient. The mean Disabilities of the Arm, Shoulder, and Hand score was 15 (range, 0–66.4). The mean Constant-Murley score was 87 (range, 51–95).

Conclusions

Low rates of complication and high clinical outcome scores can be achieved when treating complex proximal humerus fractures with locking-plate fixation and an endosteal strut augment.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

The authors thank Omesh Paul, MD, for his help in data collection for this study.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew S. Neviaser MD.

Additional information

One of the authors (JSD) has received fees for consulting from BioMimetic Therapeutics (Franklin, TN), Tornier Sports Medicine (Edina, MN), and Arthrex, Inc (Naples, FL). Each of the other authors certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at The Hospital for Special Surgery.

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Neviaser, A.S., Hettrich, C.M., Beamer, B.S. et al. Endosteal Strut Augment Reduces Complications Associated With Proximal Humeral Locking Plates. Clin Orthop Relat Res 469, 3300–3306 (2011). https://doi.org/10.1007/s11999-011-1949-0

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  • DOI: https://doi.org/10.1007/s11999-011-1949-0

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