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

Panchal, Karnav; Jeong, Jong Ju; Park, Sang-Eun; Kim, Weon-Yoo; Min, Hyung-Ki; Kim, Ju-Yeong; Ji, Jong‐Hun

doi:10.1007/s00264-015-2950-0

Cited by 49 publications

(53 citation statements)

References 27 publications

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“…[53][54][55] Fibula struts show promise, although clinical studies in the current literature are of a small sample size. 56,57 Femoral head allograft augmentation has shown similar results in a group of ten patients, with an average post-op constant score of 72 at 28 months, and one non-union (10%). 58 Although clinical results are promising, these techniques are not without complications, 59 and there are no studies with a control group to allow for comparison.…”

Section: Augmentationmentioning

confidence: 83%

Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?

et al. 2019

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The ultimate goal of management of proximal humeral fractures in the elderly patient is to get the patient independently mobile. This article will review the current literature regarding this cohort of patient. Recent Cochrane reviews and a large multicentre randomised study question the role of surgical intervention. Implant design is evolving rapidly, and many elderly patients now behave more like the younger patient. There remains little compelling evidence to guide decision-making for the complex proximal humeral fracture in the elderly, and the decision needs to be made on a case-by-case basis taking into account the patient's comorbidities, the fracture pattern and characteristics, the attending surgeon's skill sets, and the availability of equipment.

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Section: Augmentationmentioning

confidence: 83%

Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?

et al. 2019

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“…Restoration of medial column support with a locking plate, calcar screw insertion, and fibular strut graft augmentation has been a representative restorative tool for PHFs, and there is abundant evidence of their use and effectiveness. 2,[8][9][10][11][12][13][14][15][16][17][18] However, in this study, we chose to use a TIA instead of a fibular strut allograft.…”

Section: Discussionmentioning

confidence: 99%

“…6,7) For restoration of the medial metaphyseal area in PHFs in which the medial cortical support is broken and disrupted, fixation via a strut support with a fibular allograft and insertion of calcar screws has been used and that approach's efficacy has been evaluated in recent years. 2,[8][9][10][11][12][13][14][15][16][17][18][19] We have had several bad experiences with the application of fibular allografts in unstable PHFs, including graft breakage during drilling, further displacement of the fracture gap for long graft insertion, and reduction loss with later graft displacement after graft fixation with push screws.…”

Section: Introductionmentioning

confidence: 99%

Strut Support with Tricortical Iliac Allografts in Unstable Proximal Humerus Fractures: Surgical Indication and New Definition of Poor Medial Column Support

Lee

Hyun

Baek

2019

Clin Shoulder Elbow

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Background: The execution of fibular allograft augmentation in unstable proximal humerus fractures (PHFs) was technically demanding. In this study, the authors evaluated the clinical and radiographic outcomes after tricortical iliac allograft (TIA) augmentation in PHFs.Methods: We retrospectively assessed 38 PHF patients treated with locking-plate fixation and TIA augmentation. Insertion of a TIA was indicated when an unstable PHF showed a large cavitary defect and poor medial column support after open reduction, regardless of the presence of medial cortical comminution in preoperative images. Radiographic imaging parameters (humeral head height, HHH; humeral neck-shaft angle, HNSA; head mediolateral offset, HMLO; and status of the union), Constant score, and range of motion were evaluated. Patients were grouped according to whether the medial column support after open reduction was poor or not (groups A and B, respectively); clinical outcomes were compared for all parameters.Results: All fractures healed radiologically (average duration to complete union, 5.8 months). At final evaluation, the average Constant score was 73 points and the mean active forward flexion was 148°. Based on the Paavolainen assessment method, 33 patients had good results and 5 patients showed fair results. The mean loss of reduction was 1.32 mm in HHH and 5.02% in HMLO. None of the parameters evaluated showed a statistically significant difference between the two groups (poor and not poor medial column support).Conclusions: In unstable PHFs, TIA augmentation can provide good clinical and radiological results when there are poor medial column support and a large cavitary defect after open reduction.

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“…Although we were unable to compare the postoperative value with the preoperative value in this study, as we evaluated the functional scores only after surgery, the postoperative functional scores in this study was comparable to them in other previous studies. [15][16][17]22,23) In surgical intervention for the unstable proximal humerus fractures with osteoporosis, the anatomical reduction at the medial calcar has been emphasized; 7,11,12) in particular, if metaphyseal comminution is combined, and therefore anatomical reduction and its maintenance were not feasible, other options, such as inferomedial calcar screw or intramedullary strut bone graft, should be considered. Gardner et al 7) emphasized the importance of medial support (either by anatomical reduction of medial cortex or oblique locking screw placement for medial calcar support) in locking the plate fixation of proximal humerus fractures.…”

Section: Discussionmentioning

confidence: 99%

“…7) Previous investigators described the importance of anatomic reduction and mechanical support of medial calcar in proximal humerus fractures, reporting high failure rate or varus malunion without medial column support in cases of concomitant comminuted fracture at the medial calcar. [7][8][9][10][11][12] Since Walch et al 13) used the intramedullary bone peg technique in treating nonunion at the humeral surgical neck, Gardner et al 14) used a fibular strut allograft as an endosteal implant and support for proximal humerus fractures in small series [14][15][16][17][18] The purpose of this study was to investigate the clinical and radiological outcomes of locking plate fixation with a fibular strut allograft for unstable osteoporotic proximal humerus fractures. We hypothesized that the use of fibular strut allograft as an internal pillar may be a good option for preventing varus collapse and maintaining the initial reduction status.…”

Section: Introductionmentioning

confidence: 99%

Operative Treatment with Intramedullary Fibular Strut Allograft for Osteoporotic Proximal Humerus Fracture

Chun

Lee

2017

Clinics in Shoulder and Elbow

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Background: The purpose of this study was to investigate the clinical and radiological outcomes of locking plate fixation with fibular strut allograft to manage unstable osteoporotic proximal humerus fractures. Methods: We retrospectively reviewed 15 patients who underwent open reduction and locking plate fixation with fibular strut allograft for osteoporotic proximal humerus fracture between July 2011 and June 2015. For functional evaluation, we evaluated visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion. For radiological evaluation, shoulder true anteroposterior (AP) and AP in 20° external rotation, as well as the axillary view were taken at two weeks, six weeks, three months, six months, and one year. And the neck-shaft angle was measured on the AP view in 20° external rotation view. Results: At the one-year follow-up, mean VAS pain score and all shoulder scores, including ASES score and UCLA shoulder score, exhibited satisfactory clinical outcomes. All patients obtained bone union between three and six months post-procedure. Moreover, the mean immediate postoperative neck-shaft angle was 138° ± 4°, and at one-year follow-up, the neck shaft angle was 137° ± 5°. There was no significant difference between the preoperative and postoperative values (p=0.105). Conclusions: For the unstable two-part and three-part osteoporotic proximal humerus fractures with medial calcar comminution, the use of fibular strut allograft with locking plate fixation was effective in maintaining the initial status of reduction and exhibiting the satisfactory functional and radiological outcomes.

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

Cited by 49 publications

References 27 publications

Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?

Management of complex proximal humerus fractures in the elderly: what is the role of open reduction and internal fixation?

Strut Support with Tricortical Iliac Allografts in Unstable Proximal Humerus Fractures: Surgical Indication and New Definition of Poor Medial Column Support

Operative Treatment with Intramedullary Fibular Strut Allograft for Osteoporotic Proximal Humerus Fracture

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