Clinical outcomes of allograft with locking compression plates for elderly four-part proximal humerus fractures

Hua Chen, Xinran Ji, Qun Zhang, Xiangdang Liang, Peifu Tang, Hua Chen, Xinran Ji, Qun Zhang, Xiangdang Liang, Peifu Tang

Abstract

Background: The aim of this study is to explore the clinical outcomes of anatomical allograft or fibula shaft augmentation with locking compression plates (LCPs) in elderly patients with four-part proximal humeral fracture (PHF).

Methods: A total of 22 elderly patients with four-part PHF underwent allograft augmentation with LCPs for treatment. Among them, 7 cases received anatomical allograft and 15 patients received fibula shaft. Constant-Murley score (CMS), the disability of the arm, shoulder and hand (DASH) score, and subjective ratings, radiographic imaging, range of motion (ROM), and complications were recorded as postoperative evaluations.

Results: Although the ROM and strength were considerably limited compared with the normal side, there were no significant differences in pain and daily activity between the unaffected and affected sides at the last follow-up according to the CMS. Additionally, no significant differences were found in the subjective ratings and CMS and DASH scores between the patients augmented with fibular shaft and anatomical allograft. Among the 15 patients who received fibular shaft, one case developed avascular necrosis (AVN) and screw cutout, but satisfactory outcomes were obtained after removal of implant. Besides, varus displacement occurred in one case, the patient acquired good function without revision. There were no infection, bone nonunion, and hardware-related complications occurred in any case.

Conclusions: Both anatomical allograft and fibula shaft with LCPs showed relatively good clinical outcomes for elderly patients with four-part PHF.

Figures

Fig. 1
Fig. 1
Two kinds of allografts for medial support. a Fibular allograft. b Anatomical allograft
Fig. 2
Fig. 2
The humeral head and shaft are reduced with the help of laminar spreader under fluoroscopy and fixed by locking compression plates. a Before reduction. b Reduction with the help of laminar spreader. c Insertion of fibula. d Fixation by steel plate and screw
Fig. 3
Fig. 3
One case develops AVN and screw cutout but gets satisfactory outcomes after the implant is being removed. a X-ray film before surgery. b X-ray film after surgery. c X-ray film 3 months after surgery. d X-ray film 12 months after surgery. e, f X-ray film 30 months after surgery. g, h Function of patient’s upper arm
Fig. 4
Fig. 4
One case develops varus displacement but acquires good function without need of revision. a X-ray film before surgery. b X-ray film 3 days after surgery. c X-ray film 3 months after surgery. d X-ray film 38 months after surgery. e-g Function of patient’s upper arm

References

    1. Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, 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. doi: 10.1097/00001648-199611000-00008.
    1. Vachtsevanos L, Hayden L, Desai AS, Dramis A. Management of proximal humerus fractures in adults. World J Orthoped. 2014;5(5):685. doi: 10.5312/wjo.v5.i5.685.
    1. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta orthopaedica Scandinavica. 2001;72(4):365–71. doi: 10.1080/000164701753542023.
    1. Burkhart KJ, Dietz SO, Bastian L, Thelen U, Hoffmann R, Muller LP. The treatment of proximal humeral fracture in adults. Deutsches Arzteblatt international. 2013;110(35-36):591–7.
    1. Gaebler C, McQueen M, Court-Brown C. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthopaedica. 2003;74(5):580–5. doi: 10.1080/00016470310017992.
    1. Naranja RJ, Iannotti JP. Displaced three- and four-part proximal humerus fractures: evaluation and management. J Am Acad Orthop Surg. 2000;8(6):373–82.
    1. Yüksel HY, Yimaz S, Aksahin E, Çelebi L, Muratli HH, Biçimoglu A. The results of nonoperative treatment for three-and four-part fractures of the proximal humerus in low-demand patients. J Orthop Trauma. 2011;25(10):588–95. doi: 10.1097/BOT.0b013e318210ea56.
    1. Iyengar JJ, Devcic Z, Sproul RC, Feeley BT. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma. 2011;25(10):612–7. doi: 10.1097/BOT.0b013e3182008df8.
    1. Phipatanakul W, Norris T. Indications for prosthetic replacement in proximal humeral fractures. Instr Course Lect. 2004;54:357–62.
    1. Aaron D, Parsons B, Sirveaux F, Flatow E. Proximal humeral fractures: prosthetic replacement. Instr Course Lect. 2012;62:155–62.
    1. Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg. 2008;90(11):1407–13. doi: 10.1302/0301-620X.90B11.21070.
    1. Clavert P, Adam P, Bevort A, Bonnomet F, Kempf J-F. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg. 2010;19(4):489–94. doi: 10.1016/j.jse.2009.09.005.
    1. 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. doi: 10.1016/j.jse.2010.01.001.
    1. Kim SH, Lee YH, Chung SW, Shin SH, Jang WY, Gong HS, et al. Outcomes for four-part proximal humerus fractures treated with a locking compression plate and an autologous iliac bone impaction graft. Injury. 2012;43(10):1724–31. doi: 10.1016/j.injury.2012.06.029.
    1. Singer G, Ferlic P, Kraus T, Eberl R. Reconstruction of the sternoclavicular joint in active patients with the figure-of-eight technique using hamstrings. J Shoulder Elbow Surg. 2013;22(1):64–9. doi: 10.1016/j.jse.2012.02.009.
    1. Pingsmann A, Patsalis T, Michiels I. Resection arthroplasty of the sternoclavicular joint for the treatment of primary degenerative sternoclavicular arthritis. J Bone Joint Surg. 2002;84(4):513–7. doi: 10.1302/0301-620X.84B4.12601.
    1. Barrett JA, Baron JA, Karagas MR, Beach ML. Fracture risk in the US Medicare population. J Clin Epidemiol. 1999;52(3):243–9. doi: 10.1016/S0895-4356(98)00167-X.
    1. Cai M, Tao K, Yang C, Li S. Internal fixation versus shoulder hemiarthroplasty for displaced 4-part proximal humeral fractures in elderly patients. Orthopedics. 2012;35(9):748.
    1. Edelson G, Safuri H, Salami J, Vigder F, Militianu D. Natural history of complex fractures of the proximal humerus using a three-dimensional classification system. J Shoulder Elbow Surg. 2008;17(3):399–409. doi: 10.1016/j.jse.2007.08.014.
    1. 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. doi: 10.1016/S1058-2746(05)80001-1.
    1. Peng C-H, Wu W-T, Yu T-C, Chen L-C, Hsu S-H, Kwong S-T, et al. Surgical treatment for proximal humeral fracture in elderly patients with emphasis on the use of intramedullary strut allografts. Tzu Chi Medical Journal. 2012;24(3):131–5. doi: 10.1016/j.tcmj.2012.08.010.
    1. Russo R, Visconti V, Lombardi LV, Ciccarelli M, Giudice G. The block-bridge system: a new concept and surgical technique to reconstruct articular surfaces and tuberosities in complex proximal humeral fractures. J Shoulder Elbow Surg. 2008;17(1):29–36. doi: 10.1016/j.jse.2007.03.027.
    1. Neviaser AS, Hettrich CM, Beamer BS, Dines JS, Lorich DG. Endosteal strut augment reduces complications associated with proximal humeral locking plates. Clin Orthop Relat Res. 2011;469(12):3300–6. doi: 10.1007/s11999-011-1949-0.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe