Proximal humeral internal locking system combined with fibular strut allograft for treatment of Neer 3- and 4-part factures of proximal humerus in the elderly

Abstract

Objective To compare proximal humeral internal locking system (PHILOS) combined with fibular strut allograft versus simple PHILOS for the treatment of Neer 3- and 4-part factures of proximal humerus in the elderly. Methods A retrospective study was conducted of 157 elderly patients with Neer 3- or 4-part facture of proximal humerus who had been treated at Department of Orthopaedics, Ningbo No.6 Hospital from May 2013 to October 2016. They were 76 males and 81 females, aged from 60 to 88 years (average, 76.1 years). According to the Neer classification, 100 cases were 3-part fractures and 57 4-part fractures. Of them, 35 were treated by PHILOS combined with fibular strut allograft (group A) and 122 by PHILOS alone (group B). At the last follow-up, the 2 groups were compared in terms of shoulder joint activity (anteflexion, abduction, internal rotation and external rotation), visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, postoperative height loss of the humeral head, humeral head varus angle, complication rate and secondary surgery rate. Results The 157 patients were followed up for 12 to 22 months (mean, 16.8 months). The fracture healing time was 13.0±3.8 weeks in group A and 15.6±4.2 weeks in group B, showing a statistically significant difference (P 0.05). Conclusions In the treatment of Neer 3- and 4-part factures of proximal humerus in the elderly, PHILOS combined with fibular strut allograft can improve therapeutic efficacy, because it can provide good support for the medial column of the proximal humerus and the humeral head and thus facilitate the intraoperative reduction of the fracture. Key words: Shoulder fracture; Fracture fixation, internal; Bone plate; Elderly; Allogenic humerus