Abstract
BackgroundThe 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).MethodsA 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.ResultsAlthough 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.ConclusionsBoth anatomical allograft and fibula shaft with LCPs showed relatively good clinical outcomes for elderly patients with four-part PHF.
Highlights
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)
We evaluated the outcomes of elderly patients with fresh four-part PHF who underwent fibular shaft or anatomical allograft for restoration of medial strut with LCPs
There were no significant differences in pain (P = 0.7145) and activity (P = 0.6396) between the fractured side and the normal side, the range of motion (ROM) (P < 0.05) and strength (P < 0.05) were considerably limited compared with the normal side
Summary
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). Most PHFs are low-energy osteoporotic injury occurred in the elderly and afflict two or three times as many women as men [3]. This fracture still remains a major challenge for surgeons worldwide [4]. The fixed-angle construct could improve the fracture stability and increase the resistance to pullout through the bone-plate interface with a single beam construct, especially useful in poor-quality cancellous bone of the proximal humerus. Some complications, such as avascular necrosis (AVN), screw cutout, implant
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