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
Commentary: Locking Plate Fixation with and without Inferomedial Screws for Proximal Humeral Fractures: A Biomechanical Study
