scholarly journals Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Xueliang Cui ◽  
Hui Chen ◽  
Binbin Ma ◽  
Wenbin Fan ◽  
He Li
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Locking Plate ◽  
External Rotation ◽  
Plate Fixation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Head Height

Abstract Background Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods We retrospectively reviewed 60 patients (mean age, 72.75 years) with closed 3- or 4-part fractures, and a minimum of 2 years of follow-up. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). The 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 LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p < 0.001] and NSA of 9.94° versus 3.12° [p < 0.001]) . The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p = 0.024] and ASES score of 72.80 vs 78.64 [p = 0.022]). The FA group showed better forward elevation (p = 0.010) and abduction (p = 0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p < 0.001). Conclusion For comminuted PHFs in elderly patients, LCP fixation combined with a fibular allograft is reasonable option to ensure satisfactory radiological and clinical outcomes. Trial registration ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. Date of registration: 2018-05-17.

scholarly journals Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

2019 ◽  
Author(s):  
Xueliang Cui ◽  
Hui chen ◽  
Binbin Ma ◽  
Wenbin Fan ◽  
He Li
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Locking Plate ◽  
External Rotation ◽  
Plate Fixation ◽  
Humeral Fracture ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Neck Shaft Angle ◽  
Head Height

Abstract Background: Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods: We retrospectively reviewed 60 patients (mean age, 72.75 years) with closed 3- or 4-part fractures, and a minimum of 2 years of follow-up. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). The 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 LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p<0.001] and NSA of 9.94° versus 3.12° [p<0.001 ]). The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p=0.024] and ASES score of 72.80 vs 78.64 [p=0.022]). The FA group showed better forward elevation (p=0.010) and abduction (p=0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p<0.001). Conclusion: For comminuted PHFs in elderly patients, LCP fixation combined with a fibular allograft is reasonable option to ensure satisfactory radiological and clinical outcomes. Trial registration: ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. URL of registry: http://www.njzdyy.com. Date of registration: 2018-05-17 Key words: proximal humeral fracture; fibular allograft; locking plate; elderly patients

scholarly journals Fibular strut allograft influences reduction and outcome after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

2019 ◽  
Author(s):  
Xueliang Cui ◽  
Hui chen ◽  
Binbin Ma ◽  
Wenbin Fan ◽  
He Li
Keyword(s):  
Locking Plate ◽  
Plate Fixation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Locking Plate Fixation ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Head Height ◽  
Fibular Strut ◽  
Fibular Strut Allograft

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

scholarly journals Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

2019 ◽  
Author(s):  
Xueliang Cui ◽  
Hui chen ◽  
Binbin Ma ◽  
Wenbin Fan ◽  
He Li
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Locking Plate ◽  
Plate Fixation ◽  
Humeral Fractures ◽  
Locking Plate Fixation ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Fibular Strut ◽  
Fibular Strut Allograft

Abstract Abstract Background: Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods: A retrospective review was performed on 60 three- and four-part PHFs . The outcomes were assessed for 35 patients in the LCP group and 25 in the LCP with fibular allograft (FA) group, with a mean age of 72.75 years (60 to 88), at a mean follow-up of 31.95 months (24 to 40). 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 the neck-shaft angle (NSA) was more than 5° or if the change in HHH was more than 3 mm. The 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 LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p<0.001] and NSA of 9.94° versus 3.12° [p﹤0.001 ]). The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p=0.024] and ASES score of 72.80 vs 78.64 [p=0.022]). The FA group showed better forward elevation (p=0.010) and abduction (p=0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p<0.001). Conclusion: For comminuted PHFs in elderly patients, locking plate fixation with a fibular strut allograft showed satisfactory radiological and clinical outcomes. Trial registration: ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. URL of registry: http://www.njzdyy.com. Date of registration: 2018-05-17 Key words: proximal humeral fracture; fibular allograft; locking plate; elderly patients

scholarly journals Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

2019 ◽  
Author(s):  
Xueliang Cui ◽  
Hui chen ◽  
Binbin Ma ◽  
Wenbin Fan ◽  
He Li
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Locking Plate ◽  
Plate Fixation ◽  
Humeral Fractures ◽  
Locking Plate Fixation ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Fibular Strut ◽  
Fibular Strut Allograft

Abstract Abstract Background: Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods: A retrospective review was performed on 60 three- and four-part PHFs . The outcomes were assessed for 35 patients in the LCP group and 25 in the LCP with fibular allograft (FA) group, with a mean age of 72.75 years (60 to 88), at a mean follow-up of 31.95 months (24 to 40). 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 the neck-shaft angle (NSA) was more than 5° or if the change in HHH was more than 3 mm. The 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 LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p<0.001] and NSA of 9.94° versus 3.12° [p﹤0.001 ]). The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p=0.024] and ASES score of 72.80 vs 78.64 [p=0.022]). The FA group showed better forward elevation (p=0.010) and abduction (p=0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p<0.001). Conclusion: For comminuted PHFs in elderly patients, locking plate fixation with a fibular strut allograft showed satisfactory radiological and clinical outcomes. Trial registration: ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. URL of registry: http://www.njzdyy.com. Date of registration: 2018-05-17 Key words: proximal humeral fracture; fibular allograft; locking plate; elderly patients

scholarly journals Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

2019 ◽  
Author(s):  
Won Chul Shin ◽  
Suk-Woong Kang ◽  
Seung Min Son ◽  
Hyuk Bae
Keyword(s):  
Surgical Treatment ◽  
Locking Plate ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Bone Union ◽  
Neck Shaft Angle ◽  
Radiological Results ◽  
Comminuted Fracture ◽  
Shaft Angle ◽  
The Mean

Abstract Background: To evaluate the results of surgical treatment using a locking plate for proximal humeral fractures in patients aged >80 years. Methods: Between September of 2013 and March of 2016, there were 22 patients who received locking plate fixation from proximal humeral fractures over 80 years-old. Among the 22 cases, Clinical, radiological results were analyzed for 19 patients who were able to follow up more than one year. We analyzed bone union, neck-shaft angle, UCLA score, range of motion compared to opposite side and complication. Clinical, radiological results were investigated for medial comminuted fracture or not. Results: All the patients achieved bone union. The mean bone union time was 13.7 weeks, and the mean neck-shaft angle was 126.4. The mean University of California, Los Angeles, shoulder score was 22.4, and score was <28 point in 12 patients. The mean forward flexion, abduction, external rotation, and internal rotation angles were 129.2°, 112.3°, 44.2°, and L2. All motions were significantly different from the normal shoulder motion. A significant difference was found in the loss of neck-shaft angle according to the medial comminuted fracture. Conclusion: In the surgical treatment of proximal humeral fractures in patients aged >80 years, use of a locking plate attained bone union with relatively satisfactory results. However, we considered that prevention of and training for postoperative stiffness are necessary. Other surgical methods should be considered for patients with complex displaced fractures, especially those with medial comminuted fractures.

Outcomes of locking plate fixation with fibular allograft augmentation for proximal humeral fractures in osteoporotic patients

2019 ◽  
Vol 101-B (3) ◽  
pp. 260-265 ◽  
Author(s):  
S. H. Lee ◽  
S. S. Han ◽  
B. M. Yoo ◽  
J. W. Kim
Keyword(s):  
Humeral Head ◽  
Locking Plate ◽  
Plate Fixation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Locking Plate Fixation ◽  
Neck Shaft Angle ◽  
Fibular Strut ◽  
Fibular Strut Allograft

Aims The aim of this study was to evaluate the clinical and radiological outcomes of locking plate fixation, with and without an associated fibular strut allograft, for the treatment of displaced proximal humeral fractures in elderly osteoporotic patients. Patients and Methods We undertook a retrospective comparison of two methods of fixation, using a locking plate without an associated fibular strut allograft (LP group) and with a fibular allograft (FA group) for the treatment of these fractures. The outcome was assessed for 52 patients in the LP group and 45 in the FA group, with a mean age of 74.3 years (52 to 89), at a mean follow-up of 14.2 months (12 to 19). The clinical results were evaluated using a visual analogue scale (VAS) score for pain, the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the range of movement. Radiological results were evaluated using the neck-shaft angle (NSA) and humeral head height (HHH). Results The mean forward elevation in the LP and FA groups was 125.3° (sd 21.4) and 148.9° (sd 19.8), respectively (p = 0.042), while other clinical factors showed no statistically significant differences between the groups. The changes in NSA and HHH immediately after the operation and at final follow-up were significantly better in the FA group than in the LP group (p = 0.015 and p = 0.021, respectively). Conclusion For comminuted proximal humeral fractures in osteoporotic patients, locking plate fixation with a fibular strut allograft shows satisfactory short-term results with respect to humeral head support and maintenance of reduction, and may reduce the incidence of complications associated with fixation using a locking plate alone. Cite this article: Bone Joint J 2019;101-B:260–265.

scholarly journals Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

2019 ◽  
Author(s):  
Won Chul Shin ◽  
Suk-Woong Kang ◽  
Seung Min Son ◽  
Hyuk Bae
Keyword(s):  
Surgical Treatment ◽  
Locking Plate ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Bone Union ◽  
Neck Shaft Angle ◽  
Radiological Results ◽  
Surgical Methods ◽  
Shaft Angle ◽  
The Mean

Abstract Background: To evaluate the results of surgical treatment using a locking plate for proximal humeral fractures in patients aged >80 years. Methods: Between September of 2013 and March of 2016, there were 22 patients who received locking plate fixation from proximal humeral fractures over 80 years-old. Among the 22 cases, Clinical, radiological results were analyzed for 19 patients who were able to follow up more than one year. We analyzed bone union, neck-shaft angle, UCLA score, range of motion compared to opposite side and complication. Clinical, radiological results were investigated for medial comminuted fracture or not.Results: All the patients achieved bone union. The mean bone union time was 13.7 weeks, and the mean neck-shaft angle was 126.4. The mean University of California, Los Angeles, shoulder score was 22.4, and score was <28 point in 12 patients. The mean forward flexion, abduction, external rotation, and internal rotation angles were 129.2°, 112.3°, 44.2°, and L2. All motions were significantly different from the normal shoulder motion. A significant difference was found in the loss of neck-shaft angle according to the medial comminuted fracture.Conclusion: In the surgical treatment of proximal humeral fractures in patients aged >80 years, use of a locking plate attained bone union with relatively satisfactory results. However, we considered that prevention of and training for postoperative stiffness are necessary. Other surgical methods should be considered for patients with complex displaced fractures, especially those with medial comminuted fractures.

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