Doo-Sup Kim1, Doo-Hyung Lee2, Yong-Min Chun3, Sang-Jin Shin4. 1. Department of Orthopaedic Surgery, Wonju College of Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju, Republic of Korea. 2. Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea. 3. Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea. 4. Department of Orthopaedic Surgery, Ewha Shoulder Disease Center, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea. Electronic address: sjshin622@ewha.ac.kr.
Abstract
BACKGROUND: The purpose of this study was to compare clinical and radiologic results between treatment with locking plate fixation and fibular allograft augmentation (FA) and treatment with locking plate fixation and additional inferomedial screws (IMSs) in 3- or 4-part proximal humeral fractures with medial comminution in geriatric patients. METHODS: We enrolled 164 patients with 3- or 4-part proximal humeral fractures with medial comminution who were treated with locking plates. The patients were divided into 2 groups according to additional augmented fixation procedures. The IMS group was composed of patients treated with additional IMSs (80 patients), whereas the FA group was treated with an additional fibular allograft (84 patients). On the basis of fracture classification, the IMS group was subdivided into those with 3-part fractures (52 patients) and those with 4-part fractures (28 patients) and the FA group was subdivided into those with 3-part fractures (55 patients) and those with 4-part fractures (29 patients). Clinical and radiographic results were compared and analyzed. RESULTS: In patients with 3-part fractures, no differences in clinical outcomes were found regardless of additional procedures. However, the FA group showed superior clinical outcomes in patients with 4-part fractures (P = .038 for Constant score and P = .045 for visual analog scale score). The postoperative neck-shaft angle was maintained in the FA group compared with the IMS group with both fracture types at the last follow-up (P = .048 for IMS vs FA with 3-part fractures and P = .023 for IMS vs FA with 4-part fractures). The number of complications was significantly higher in the IMS group (5.5%) than in the FA group (1.2%) (P = .001). CONCLUSION: An FA technique is considered a primary additional procedure for medial support in patients with 4-part proximal humeral fractures involving medial metaphyseal comminution when treated with locking plate fixation.
BACKGROUND: The purpose of this study was to compare clinical and radiologic results between treatment with locking plate fixation and fibular allograft augmentation (FA) and treatment with locking plate fixation and additional inferomedial screws (IMSs) in 3- or 4-part proximal humeral fractures with medial comminution in geriatric patients. METHODS: We enrolled 164 patients with 3- or 4-part proximal humeral fractures with medial comminution who were treated with locking plates. The patients were divided into 2 groups according to additional augmented fixation procedures. The IMS group was composed of patients treated with additional IMSs (80 patients), whereas the FA group was treated with an additional fibular allograft (84 patients). On the basis of fracture classification, the IMS group was subdivided into those with 3-part fractures (52 patients) and those with 4-part fractures (28 patients) and the FA group was subdivided into those with 3-part fractures (55 patients) and those with 4-part fractures (29 patients). Clinical and radiographic results were compared and analyzed. RESULTS: In patients with 3-part fractures, no differences in clinical outcomes were found regardless of additional procedures. However, the FA group showed superior clinical outcomes in patients with 4-part fractures (P = .038 for Constant score and P = .045 for visual analog scale score). The postoperative neck-shaft angle was maintained in the FA group compared with the IMS group with both fracture types at the last follow-up (P = .048 for IMS vs FA with 3-part fractures and P = .023 for IMS vs FA with 4-part fractures). The number of complications was significantly higher in the IMS group (5.5%) than in the FA group (1.2%) (P = .001). CONCLUSION: An FA technique is considered a primary additional procedure for medial support in patients with 4-part proximal humeral fractures involving medial metaphyseal comminution when treated with locking plate fixation.
Authors: Sascha Halvachizadeh; Till Berk; Thomas Rauer; Christian Hierholzer; Roman Pfeifer; Hans-Christoph Pape; Florin Allemann Journal: PLoS One Date: 2020-04-09 Impact factor: 3.240