Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Matassi, Fabrizio; Angeloni, R.; Carulli, Christian; Civinini, Roberto; Bella, Leonardo di; Redl, Birgit; Innocenti, Massimo

doi:10.1016/j.injury.2012.08.004

Cited by 92 publications

(68 citation statements)

References 21 publications

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“…Based on these factors, our study population may be divided in Group 2 and Group 3 according to NUSS (1). Some studies show that non union is a variable outcome, highly influenced by the perforation of the articular surface with screws or varus collapse, especially in comminuted osteoporotic bone fractures of the medial plateau (15). Adequate mechanical medial column support may be obtained by an anatomical reduction of the fracture and a medial cortical contact in the case of comminution, by placing an oblique locking screw from the inferomedial region of the proximal fragment (15,16).…”

Section: Discussionmentioning

confidence: 99%

Grafting and fixation of proximal humeral aseptic non union: a prospective case series

Rollo

Rotini

Pichierri

et al. 2017

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SummaryBackground. Fractures of the proximal part of the humerus represent almost 4-5% of all fractures. The rate of non union is estimated to be 1.1 to 10%. Non union, displacement, and fixation failure can be hazardous complications for these injuries. The purpose of our study was to evaluate the outcomes of plate and bone strut allograft with bone chips grafting augmentation in the management of proximal humeral aseptic non union. Methods. We treated 16 aseptic non union proximal humeral fractures by the medial humeral shaft bone strut allograft and lateral plate and screws with bone chips grafting. The patients' ages were between 55 and 70 years. The chosen criteria to evaluate the group during the clinical and radiological follow-up were the quality of life measured by The Short Form (12) Health Survey (SF-12), shoulder function and related quality of life measured by the Constant Shoulder Score (CSS) compared with healthy side, bone healing measured by X-rays, and postoperative complications. The follow-up was perfor med with clinical and radiographic controls at 1, 3, 6 and 12 months. Surgical time and international units of red blood cells transfused were also calculated. The evaluation endpoint was set at 12 months. Results. The X-rays bone healing occurred in our group on average of 126.4 days after surgery. The surgical time and blood loss were consistent with standard surgical procedures. The quality of life and functional recovery were excellent after plate and bone strut allograft. Conclusions. Surgical techniques that increase mecha nical stability, while incorporating bone biology, are effective aids for treating problematic fractural patterns.KEY WORDS: aseptic non union; proximal humeral fracture outcome; bone strut allograft; plate; osteosynthesis; complications.

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Section: Discussionmentioning

confidence: 99%

Grafting and fixation of proximal humeral aseptic non union: a prospective case series

Rollo

Rotini

Pichierri

et al. 2017

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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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“…2) Although most proximal humerus fractures are treatable by conservative treatment, those with unstable proximal humerus fractures, 3-part fracture, 4-part fracture, or medial metaphyseal disruption frequently undergo locking plate and fibular surgical treatments using allograft augmentation. 16,17) Chow et al 22) explained how fibula allograft augmentation withstood the repetitive varus loading using the cadevaric specimens. Furthermore, when using fibular allograft augmentation, compared with when using only the locking compression plate, it was confirmed that the former can withstand greater loads.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, these techniques have been used well in the medial metaphyseal disruption and osteoporotic bone, and as a result, considered to be good. [16][17][18] However, to date, only a few studies have been conducted in Korea investigating the clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate.…”

Section: Introductionmentioning

confidence: 99%

The Outcomes of Proximal Humerus Fractures with Medial Metaphyseal Disruption Treated with Fibular Allograft Augmentation and Locking Plate

Kim

Yoon

Kang

et al. 2017

Clinics in Shoulder and Elbow

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Background: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. Methods: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. Results: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. Conclusions: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies. (Clin Shoulder Elbow 2017;20(2):90-94)

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Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Cited by 92 publications

References 21 publications

Grafting and fixation of proximal humeral aseptic non union: a prospective case series

Grafting and fixation of proximal humeral aseptic non union: a prospective case series

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

The Outcomes of Proximal Humerus Fractures with Medial Metaphyseal Disruption Treated with Fibular Allograft Augmentation and Locking Plate

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