The effect of medial calcar support on proximal humeral fractures treated with locking plates

Abstract

Background Studies have reported mixed results on the importance of medial calcar support for the treatment of proximal humeral fractures. The purpose of this study was to compare radiographic and functional outcomes of patients who had displaced proximal humeral fractures with varying levels of medial support. Methods We performed a retrospective comparative cohort study. The study was conducted at a Level III trauma center in Taiwan. Seventy patients with proximal humeral fractures were collected retrospectively from 2015 to 2019. Only patients with two-, three-, or four-part types (Neer type I, II, or III) of displaced proximal humeral fractures were included in this study. However, patients with head-split fracture patterns, shoulder dislocation, prior shoulder trauma, and poor fracture reduction present in postoperative films were excluded. We assessed the radiographic outcomes, including the reduction score and amount of impaction in the humeral head. The functional outcome was evaluated based on the Constant score. Results Patients were grouped into the intact medial calcar group and the medial calcar deficiency group. In a subgroup analysis, the group with intact medial support had a significantly lower amount of impaction and a higher Constant score compared with the medial calcar deficiency group. Additionally, the groups with intact medial support had a nonsignificant difference in the Constant score between the affected side and the contralateral side. Conclusion The amount of impaction and the reduction score in the humeral head at the 12-month radiographic follow-up were significantly higher in the group with medial support deficiency. However, the reduction score after surgery exhibited no difference. This implies that the inherent nature of medial comminution of proximal humeral fracture may lead to inferior radiographic outcomes.

Minimally invasive plate osteosynthesis of proximal humerus fractures through a modified anterior subacromial approach

“…The IMCS can be inserted under direct vision attributable to the retractor's gentle longitudinal pull on the distal end of the proximal incision. Numerous studies in the literature had demonstrated that the success of plate xation of proximal humeral fractures was related to the insertion of IMCS to increase the medial column support [20,21].…”

Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes

“…Several studies have demonstrated the importance of an anatomical fracture reduction and fixation in order to reduce complications [ 15 , 16 ]. Different techniques such as fibular allografts [ 17 , 18 ], screw tip augmentation [ 19 , 20 ] and double plating [ 21 ] have been described to enhance medial calcar support [ 22 , 23 , 24 ].…”

Assessment of surgical management for locked fracture-dislocations of the proximal humerus in patients of different ages

“…The incidence of AVN after plating for proximal humeral fractures was as high as 68%, and even reached 80% in three- and four-part fracture cases [ 20 ]. The risk factors for humeral head necrosis after plating are related to the fracture type (AO type C and Neer four-part fractures), length of the dorsomedial metaphyseal extension, degree of fracture fragment displacement, and integrity of the medial hinge [ 16 , 21 ]. In this study, the rates of both AVN and screw cut-out after ORIF in patients ≥60 years of age were higher than those in patients <60 years, with an AVN rate of 19.4% and screw cut-out rate of 19.4% in the former, and 12.5% for AVN and 8.3% for screw cut-out in the latter.…”