Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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The Outcomes of Proximal Humerus Fractures with Medial Metaphyseal Disruption Treated with Fibular Allograft Augmentation and Locking Plate

  • Kim, Doo Sup (Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine) ;
  • Yoon, Yeo Seung (Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine) ;
  • Kang, Sang Kyu (Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine) ;
  • Jin, Han Bin (Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine) ;
  • Lee, Dong Woo (Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine)
  • Received : 2016.08.18
  • Accepted : 2017.02.15
  • Published : 2017.06.30
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Abstract

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 $127.5^{\circ}$. Conclusions: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

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References

  1. Helmy N, Hintermann B. New trends in the treatment of proximal humerus fractures. Clin Orthop Relat Res. 2006;442:100-8. https://doi.org/10.1097/01.blo.0000194674.56764.c0
  2. Baron JA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone. 1996;18(3 Suppl):209S-13S. https://doi.org/10.1016/8756-3282(95)00504-8
  3. Baron JA, Karagas M, Barrett J, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. 1996;7(6):612-8. https://doi.org/10.1097/00001648-199611000-00008
  4. Gaebler C, McQueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand. 2003;74(5):580-5. https://doi.org/10.1080/00016470310017992
  5. Neer CS 2nd. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res. 2006;442:77-82. https://doi.org/10.1097/01.blo.0000198718.91223.ca
  6. Neer CS 2nd, Rockwood CA. Fractures and dislocations of the shoulder. In: Rockwood CA, Green DP, eds. Fractures. Philadelphia: Lippincott; 1975. 610.
  7. Scheck M. Surgical treatment of nonunions of the surgical neck of the humerus. Clin Orthop Relat Res. 1982;(167):255-9.
  8. Wirth MA. Late sequelae of proximal humerus fractures. Instr Course Lect. 2003;52:13-6.
  9. Weinstein DM, Bratton DR, Ciccone WJ 2nd, Elias JJ. Locking plates improve torsional resistance in the stabilization of three-part proximal humeral fractures. J Shoulder Elbow Surg. 2006;15(2):239-43. https://doi.org/10.1016/j.jse.2005.08.006
  10. Walsh S, Reindl R, Harvey E, Berry G, Beckman L, Steffen T. 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). 2006;21(10):1027-31. https://doi.org/10.1016/j.clinbiomech.2006.06.005
  11. Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg. 2010;19(4):489-94. https://doi.org/10.1016/j.jse.2009.09.005
  12. Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011;42(11):1283-8. https://doi.org/10.1016/j.injury.2011.01.017
  13. Ricchetti ET, Warrender WJ, Abboud JA. Use of locking plates in the treatment of proximal humerus fractures. J Shoulder Elbow Surg. 2010;19(2 Suppl):66-75. https://doi.org/10.1016/j.jse.2010.01.001
  14. Sudkamp N, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009;91(6):1320-8. https://doi.org/10.2106/JBJS.H.00006
  15. Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am. 2008;90(2):233-40. https://doi.org/10.2106/JBJS.F.01351
  16. Matassi F, Angeloni R, Carulli C, et al. Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus. Injury. 2012;43(11):1939-42. https://doi.org/10.1016/j.injury.2012.08.004
  17. Kilcoyne RF, Shuman WP, Matsen FA 3rd, Morris M, Rockwood CA. The neer classification of displaced proximal humeral fractures: spectrum of findings on plain radiographs and CT scans. AJR Am J Roentgenol. 1990;154(5):1029-33. https://doi.org/10.2214/ajr.154.5.2108538
  18. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52(6):1077-89. https://doi.org/10.2106/00004623-197052060-00001
  19. Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21(3):185-91. https://doi.org/10.1097/BOT.0b013e3180333094
  20. Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma. 2008;22(3):195-200. https://doi.org/10.1097/BOT.0b013e31815b3922
  21. Constant CR. Age related recovery of shoulder function after injury [thesis]. Cork: University College Cork; 1986.
  22. Chow RM, Begum F, Beaupre LA, Carey JP, Adeeb S, Bouliane MJ. Proximal humeral fracture fixation: locking plate construct ${\pm}$ intramedullary fibular allograft. J Shoulder Elbow Surg. 2012;21(7):894-901. https://doi.org/10.1016/j.jse.2011.04.015
  23. Walch G, Badet R, Nove-Josserand L, Levigne C. Nonunions of the surgical neck of the humerus: surgical treatment with an intramedullary bone peg, internal fixation, and cancellous bone grafting. J Shoulder Elbow Surg. 1996;5(3):161-8. https://doi.org/10.1016/S1058-2746(05)80001-1
  24. Tan E, Lie D, Wong MK. Early outcomes of proximal humerus fracture fixation with locking plate and intramedullary fibular strut graft. Orthopedics. 2014;37(9):e822-7. https://doi.org/10.3928/01477447-20140825-60