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Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft

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Abstract

Purpose

To evaluate the clinical and radiological outcomes of unstable proximal humeral fractures (PHFs) treated with a locking plate and fibular strut allograft.

Methods

This study included 36 patients [7 men, 29 women; mean age, 68 years (range, 22–94 years)] with unstable PHFs with medial column disruption. All patients were treated with open reduction and internal fixation using a locking plate and fibular strut allograft. Post-operative assessment included clinical outcomes, shoulder range of motion, radiographic examination, and any complications. Post-operative radiological assessment including the humerus neck-shaft angle (NSA) and the humeral head height was performed.

Results

At the mean two year follow-up visit, the mean American Shoulder and Elbow Society (ASES) and University of California, Los Angeles (UCLA) scores were 77 and 28, respectively. According to the UCLA rating scale, the result was excellent in six, good in 20, fair in six, and poor in four cases. According to the Paavolainen method, 31 patients had good results with an NSA of 130 ± 10°; three patients showed fair results with an NSA of 100–120°, and two patients experienced a poor result with an NSA of <100°. When calculating the humeral head height, the mean loss of reduction was measured as 1.6 mm (from 10.8 or 9.2 mm). Varus collapse and avascular necrosis of the humeral head was noted in two patients for each condition.

Conclusions

For unstable proximal humerus fractures, particularly in elderly patients with severe osteoporosis or in younger patients with a four-part fracture, locking plate fixation with a fibular strut allograft provided rigid medial support and showed satisfactory clinical and radiological outcomes.

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References

  1. Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, Keller RB (1996) Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology 7:612–618

    Article  CAS  PubMed  Google Scholar 

  2. Neer CS 2nd (2006) Displaced proximal humeral fractures. Part I. Classification and evaluation. Clin Orthop Relat Res 442:77–82

    Article  PubMed  Google Scholar 

  3. Walsh S, Reindl R, Harvey E, Berry G, Beckman L, Steffen T (2006) Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech (Bristol, Avon) 21(10):1027–1031

    Article  Google Scholar 

  4. Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, Kohut G, Ekelund A, Muller M, Audigé L, Babst R (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23:163–172. doi:10.1097/BOT.0b013e3181920e5b

    Article  PubMed  Google Scholar 

  5. Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21(3):185–191

    Article  PubMed  Google Scholar 

  6. Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A (2006) Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res 442:115–120. doi:10.1097/01.blo.0000194678.87258.6e

    Article  PubMed  Google Scholar 

  7. Ricchetti ET, Warrender WJ, Abboud JA (2010) Use of locking plates in the treatment of proximal humerus fractures. J Shoulder Elbow Surg 19 (2 Suppl):66–75. doi: 10.1016/j.jse.2010.01.001

  8. Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42(11):1283–1288. doi:10.1016/j.injury.2011.01.017

    Article  PubMed  Google Scholar 

  9. Hardeman F, Bollars P, Donnelly M, Bellemans J, Nijs S (2012) Predictive factors for functional outcome and failure in angular stable osteosynthesis of the proximal humerus. Injury 43(2):153–158. doi:10.1016/j.injury.2011.04.003

    Article  PubMed  Google Scholar 

  10. Lescheid J, Zdero R, Shah S, Kuzyk PR, Schemitsch EH (2010) The biomechanics of locked plating for repairing proximal humerus fractures with or without medial cortical support. J Trauma 69:1235–1242. doi:10.1097/TA.0b013e3181beed96

    Article  PubMed  Google Scholar 

  11. 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. doi:10.1097/BOT.0b013e31815b3922

    Article  PubMed  Google Scholar 

  12. Mathison C, Chaudhary R, Beaupre L, Reynolds M, Adeeb S, Bouliane M (2010) Biomechanical analysis of proximal humeral fixation using locking plate fixation with an intramedullary fibular allograft. Clin Biomech 25(7):642–646. doi:10.1016/j.clinbiomech.2010.04.006

    Article  Google Scholar 

  13. Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089

    PubMed  Google Scholar 

  14. Paavolainen P, Bjorkenheim JM, Slatis P, Paukku P (1983) Operative treatment of severe proximal humeral fractures. Acta Orthop Scand 54:374–379

    Article  CAS  PubMed  Google Scholar 

  15. Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, Duda GN (2003) Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 123:74–81

    CAS  PubMed  Google Scholar 

  16. Rockwood CA, Green DP (1994) Fractures in adults, vol 1, 3rd edn. J.B. Lippincott, Philadelphia, pp 871–927

    Google Scholar 

  17. Den Hartog D, Van Lieshout EM, Tuinebreijer WE, Polinder S, Van Beeck EF, Breederveld RS, Bronkhorst MW, Eerenberg JP, Rhemrev S, Roerdink WH, Schraa G, Van der Vis HM, Van Thiel TP, Patka P, Nijs S, Schep NW (2010) Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): a multicenter randomized controlled trial. BMC Musculoskelet Disord 25(11):97

    Article  Google Scholar 

  18. Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91:1689–1697. doi:10.2106/JBJS.H.00133

    Article  PubMed  Google Scholar 

  19. Resch H, Beck E, Bayley I (1995) Reconstruction of the valgus-impacted humeral head fracture. J Shoulder Elbow Surg 4(2):73–80

    Article  CAS  PubMed  Google Scholar 

  20. Neviaser AS, Hettrich CM, Beamer BS, Dines JS, Lorich DG (2011) Endosteal strut augment reduces complications associated with proximal humeral locking plates. Clin Orthop Relat Res 469:3300–3306

    Article  PubMed Central  PubMed  Google Scholar 

  21. Gradl G, Knobe M, Pape HC, Neuhaus PV, Ring D, Guitton T (2015) Decision making in displaced fractures of the proximal humerus: fracture or surgeon based? Int Orthop 39(2):329–334. doi:10.1007/s00264-014-2630-5

    Article  PubMed  Google Scholar 

  22. Zhang F, Zhu L, Yang D, Yang P, Ma J, Fu Q, Chen A (2015) Comparison between the spatial subchondral support plate and the proximal humeral locking plate in the treatment of unstable proximal humeral fractures. Int Orthop 39(6):1167–1173. doi:10.1007/s00264-015-2705-y

    Article  PubMed  Google Scholar 

  23. Bae JH, Oh JK, Chon CS, Oh CW, Hwang JH, Yoon YC (2011) The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. J Bone Joint Surg (Br) 98(7):937–941. doi:10.1302/0301-620X.93B7.26125

    Article  Google Scholar 

  24. Chow RM, Begum F, Beaupre LA, Carey JP, Adeeb S, Bouliane MJ (2011) Proximal humeral fracture fixation: locking plate construct ± intramedullary fibular allograft. J Shoulder Elbow Surg 21(7):894–901. doi:10.1016/j.jse.2011.04.015

    Article  PubMed  Google Scholar 

  25. Reddix RN, Russell G, Woodall J, Jackson B, Dedmond B, Webb LX (2009) Relationship between intraoperative femoral head bleeding and development of avascular necrosis after acetabular fracture surgery. J Surg Orthop Adv 18(3):129–133

    PubMed  Google Scholar 

  26. Mostafa MF, Fawzy SI (2015) Fibular strut graft for humeral aneurysmal bone cyst with varus deformity. Int Orthop 39(7):1391-1398. doi:10.1007/s00264-015-2746-2

  27. Antuna SA, Sperling JW, Cofield RH (2008) Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg 17(2):202–9. doi:10.1016/j.jse.2007.06.025

    Article  PubMed  Google Scholar 

  28. Kontakis G, Koutras C, Tosounidis T, Giannoudis P (2008) Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg (Br) 90:1407–1413

    Article  CAS  Google Scholar 

  29. Vidyadhara S, Vamsi K, Rao SK, Gnanadoss JJ, Pandian S (2009) Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion. Int Orthop 33(4):1009–1014. doi:10.1007/s00264-008-0596-x

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was approved by Daejeon St. Mary’s Hospital, no. DC10EISI0019.

Conflicts of interest

The authors report no conflicts of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, College of Medicine, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daeheung-ro 64, Jung-gu, Daejeon, 301-723, Republic of Korea

    Karnav Panchal, Jae-Jung Jeong, Sang-Eun Park, Weon-Yoo Kim, Hyung-Ki Min, Ju-Yeong Kim & Jong-Hun Ji

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  1. Karnav Panchal
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  2. Jae-Jung Jeong
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Correspondence to Sang-Eun Park or Jong-Hun Ji.

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Panchal, K., Jeong, JJ., Park, SE. et al. Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft. International Orthopaedics (SICOT) 40, 569–577 (2016). https://doi.org/10.1007/s00264-015-2950-0

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