Effect of Calcar Screw Use in Surgical Neck Fractures of the Proximal Humerus With Unstable Medial Support

Bai, Lu; Fu, Zhong-guo; An, Shuai; Zhang, Peixun; Zhang, Dianying; Jiang, Baoguo

doi:10.1097/bot.0000000000000057

Cited by 62 publications

(50 citation statements)

References 28 publications

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“…The importance of reducing and maintaining the medial calcar to provide biomechanical support for a laterally placed plate has been recognized. Researchers concluded that medial support screws played a key role in PHILOS fixation of displaced PHF, but a biomechanical study showed the addition of medial support screws had no effect on the stiffness of the medial cortex in cases with varus malunion. In addition, a clinical study demonstrated that the place of calcar screws might lead to a high risk of humeral head necrosis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three‐ or Four‐part Proximal Humerus Fractures in the Elderly

Zhao

Yang

et al. 2019

Orthopaedic Surgery

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Objective: To compare and analyze the clinical outcomes of the proximal humeral internal locking system (PHILOS) alone and the PHILOS combined with fibular allograft in the treatment of Neer three-and four-part proximal humerus fractures (PHF) in the elderly. , a total of 42 elderly patients with Neer three-or four-part PHF admitted to our hospital were randomly divided into observation group and control group, with 21 patients in each group. The observation group was treated with the PHILOS combined with fibular allograft. The control group was treated with the PHILOS alone. Perioperative parameters and fracture classification were recorded in the two groups. Function results were assessed by Visual Analog Scale (VAS), Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, and the Disability of Arm-Shoulder-Hand (DASH) score. Radiological results were evaluated using the neck-shaft angle (NSA) and humeral head height (HHH), and complications were also recorded in each group.Results: There were no significant differences between the two groups in terms of preoperative status, age, gender, cause of trauma, fracture site, and fracture classification. The average follow-up time was 12 months. At the last follow-up, the VAS and DASH observation groups were lower than the control group, and there was significant difference between the two groups (P < 0.05). The CMS and ASES were higher in the observation group than the control group, and there was significant difference between the two groups (P < 0.05). The mean difference in the NSA and HHH were lower in the observation group than the control group, and there was a significant difference between the two groups (P < 0.05). There was one postoperative complication in the observation group, which was humeral head avascular necrosis (AVN). There were seven postoperative complications in the control group, including three cases of humeral head collapse and three cases of screw cutout and one case of humeral head AVN. The incidence of postoperative complications in the observation group was significantly lower than the control group (P < 0.05), there was a significant difference between the two groups.Conclusions: For Neer three-or four-part PHF in the elderly patients, PHILOS fixation with fibular allograft shows satisfactory short-term results with respect to humeral head support and maintenance of reduction, and may reduce the incidence of complications associated with fixation using a PHILOS alone.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three‐ or Four‐part Proximal Humerus Fractures in the Elderly

Zhao

Yang

et al. 2019

Orthopaedic Surgery

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“…The use of medial support screws has been advocated in cases of medial comminution. 1,6,20,21 Furthermore, the augmentation of head screws to compensate for low BMD has been shown to increase failure loads and stiffness after locking plate fixation of proximal humeral fractures. 5,10,14,16 Significant reductions in the complication rate with augmentation have yet to be proven.…”

mentioning

confidence: 99%

Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures

Schliemann

Seifert

Roßlenbroich

et al. 2015

Journal of Shoulder and Elbow Surgery

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“…Calcar screws play an important role in providing medial support [12, 21]. The current study showed that the calcar screws endured heavy loads from the medial column.…”

Section: Discussionmentioning

confidence: 69%

Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support

Zhang

Wang

et al. 2017

J Orthop Surg Res

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BackgroundComminuted fractures of the proximal humerus are generally treated with the locking plate system, and clinical results are satisfactory. However, unstable support of the medial column results in varus malunion and screw perforation. We designed a novel medial anatomical locking plate (MLP) to directly support the medial column. Theoretically, the combined application of locking plate and MLP (LPMP) would directly provide strong dual-column stability. We hypothesized that the LPMP could provide greater construct stability than the locking plate alone (LP), locking plate combined with a fibular graft (LPSG), and locking plate combined with a distal radius plate (LPDP).MethodsLP, LPMP, LPSG, and LPDP implants were instrumented into the finite element model of a proximal humeral fracture. Axial, shear, and rotational loads were applied to the models under normal and osteoporotic bone conditions. The whole simulation was repeated five times for each fixator. To assess the biomechanical characteristics, the construct stiffness, fracture micromotion, stress distribution, and neck-shaft angle (NSA) were compared.ResultsThe LPMP group showed significantly greater integral and regional construct stiffness, and endured less von Mises stresses, than the other three fixation methods. The stresses on the lateral locking plate were dispersed by the MLP. The LPMP group showed the least change in NSA.ConclusionsFrom the finite element viewpoint, the LPMP method provided both lateral and medial direct support. The LPMP system was effective in treating proximal humeral fracture with an unstable medial column.

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Effect of Calcar Screw Use in Surgical Neck Fractures of the Proximal Humerus With Unstable Medial Support

Abstract: In humeri with normal alignment, calcar screws can provide additional stability even when a medial deficiency exists. The use of calcar screws in humeri with varus deformity showed no biomechanical superiority.

Cited by 62 publications

References 28 publications

Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three‐ or Four‐part Proximal Humerus Fractures in the Elderly

Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three‐ or Four‐part Proximal Humerus Fractures in the Elderly

Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures

Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support

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