Primary stability of cement augmentation in locking plate fixation for proximal humeral fractures: A comparison of absorbable versus non-absorbable cement

Abstract Purpose: The purpose of this study was to determine if fibular strut allograft influence reduction and clinical outcomes after locking plate fixation of comminuted proximal humeral fractures (PHFs). Methods: A retrospective review was performed on sixty 3- and 4-part PHFs treated with either locking plate only or locking plate with a fibular allograft. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). Loss of anatomic fixation was defined if the varus malalignment of neck-shaft angle (NSA) was more than 5°or if the change of humeral head height (HHH) was more than 3 mm. Clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score. Result: The average radiological changes were higher in the locking compression plate (LCP) group than in the locking plate with fibular allograft (FA) group ( HHH of 4.16mm versus 1.18mm [p﹤0.001] and NSA of 9.94° versus 3.12° [p﹤0.001 ]). Final average outcome scores were lower in LCP group than in FA group ( CMS of 73.00 versus 78.96 [p = 0.024] and ASES score of 72.80 versus 78.64 [p = 0.022]). FA group showed better forward elevation (P=0.010) and abduction (P=0.002), but no significant differences were observed for shoulder external rotation or internal rotation. Conclusion: For comminuted proximal humerus fractures in elderly patients with severe osteoporosis, locking plate fixation with a fibular strut allograft showed satisfactory radiological and clinical outcomes. Key words: proximal humeral fractures; locking compression plate; fibular allograft

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Long contoured locking plate fixation of traumatic proximal humeral fractures with distal extension

Shoulder & Elbow ◽

10.1177/1758573214540638 ◽

2014 ◽

Vol 7 (1) ◽

pp. 18-23 ◽

Cited By ~ 2

Author(s):

Joby J George Malal ◽

Alistair I W Mayne ◽

Faten Arouri ◽

Ali M Noorani ◽

Matthew Kent ◽

...

Keyword(s):

Locking Plate ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plate Fixation ◽

Distal Extension

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Mid-term results of a less-invasive locking plate fixation method for proximal humeral fractures: a prospective observational study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-015-0618-y ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 4

Author(s):

Benjamin Bockmann ◽

Benjamin Buecking ◽

Daniel Franz ◽

Ralph Zettl ◽

Steffen Ruchholtz ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Locking Plate ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Fixation Method ◽

Locking Plate Fixation ◽

Less Invasive ◽

Mid Term Results

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Assessment of the Efficacy of the Far Cortical Locking Technique in Proximal Humeral Fractures: A Comparison with the Conventional Bi-cortical Locking Technique

10.21203/rs.2.22352/v4 ◽

2020 ◽

Author(s):

joongbae seo ◽

Yoenjun Kim ◽

Kyubeom Kim ◽

Jae-Sung Yoo

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Callus Formation ◽

Constant Score ◽

Plate Fixation ◽

Treatment Strategies ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Union Rate ◽

Locking Plate Fixation

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion)were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p=0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

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