Locking plate plus endosteal fibular allograft augmentation for proximal humeral fractures with com-minuted medial column

Abstract

Objective To evaluate the clinical and radiographic outcomes of locking plate plus endosteal fibular allograft augmentation for unstable proximal humeral fractures with comminuted medial col-umn. Methods We retrospectively analyzed the 48 patients who had been treated by locking plate plus endosteal fibular allograft augmentation and fully followed up for unstable proximal humeral fractures with comminuted medial column between June 2014 and March 2016. They were 12 men and 36 women, with an average age of 64.3 years (from 33 to 87 years). By the Neer classification, 7 cases were two-part fractures, 21 three-part fractures and 20 four-part fractures. Postoperative assessments included Constant-Murley scores, shoulder scores of Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), Short Form Health Survey (SF12), humeral head height loss, change in humeral neck shaft angle, postoperative complications and revision rate. Results Their follow-ups averaged 16.7 months (from 12 to 30 months). Their final follow-ups showed a mean Constant score of 83.3 (from 67 to 98), a mean DASH shoulder score of 18.9 (from 6.6 to 49.9), and a mean SF12 of 82.8 (from 56 to 98). Postoperatively, the humeral head height loss averaged 1.2 mm (from 0.1 to 3.4 mm) and the neck-shaft angle 3.1° (from 0.1° to 9.1°). Compli-cations happened in 5 cases (10.4%): loss of reduction in one and screw penetration out of the articular surface in 4. Conclusion Locking plate along with endosteal fibular strut allograft augmentation is a promising technique for the treatment of proximal humeral fractures with comminuted medial column because fibular strut allograft may enhance mechanical stability of the humeral head, maintain fracture reduction, re-duce humeral head height loss and complications to ensure good clinical outcomes. Key words: Shoulder fractures; Fracture fixation, internal; Bone plates; Bone transplantation