Abstract
Objectives
The study aims to evaluate outcomes of autologous iliac bone impaction grafts (AIBIGs)
with locking-compression plates (LCPs) in four-part proximal humeral fracture.
Methods
Between October 2004 and October 2008, 21 AIBIG with LCP osteosyntheses were done
for four-part proximal humeral fractures. Patients included seven males and 14 females.
Their mean age at the time of the operation was 66.3 ± 16.9 years (range: 24–87 years). Five patients had high-energy fractures other than fall from standing height.
There were two fracture-dislocation cases, and three valgus-impacted fractures. The
length of the calcar segment attached to the articular segment was 7.04 ± 6.10 mm; 13 of the 21 cases had lengths less than 8 mm. Medial-hinge displacement was 16.77 ± 15.84 mm; 19 of the 21 cases had displacements more than 2 mm.
Results
There was no avascular necrosis of the humeral head and union was achieved in all
cases. Varus collapse and hardware-related complications were not observed. Postoperative
neck-shaft angles were found to be 129 ± 9° (range: 109–146°). Neer scores were 92.0 ± 6.3 (range: 81–100).
Conclusion
The results of using AIBIG with LCP for four-part proximal humeral fractures are excellent.
There are significant bone defects in osteoporotic or comminuted fractures and LCP
alone does not always provide reliable fixation. Therefore, meticulous technique and
use of AIBIG in this complicated type of fracture can ensure a favourable outcome.
Keywords
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References
- The epidemiology of peripheral fractures.Bone. 1996; 18: 209S-213S
- Primary hemiarthroplasty in four-part fractures of the proximal humerus: randomized trial of two different implant systems.Journal of Shoulder and Elbow Surgery. 2008; 17: 210-215
- Displaced proximal humeral fractures. I. Classification and evaluation.Journal of Bone and Joint Surgery. 1970; 52: 1077-1089
- The epidemiology of proximal humeral fractures.Acta Orthopaedica Scandinavica. 2001; 72: 365-371
- Four-part fractures of the neck of the humerus.Journal of Bone and Joint Surgery: British Volume. 1984; 66: 104-108
- Proximal humeral fractures: a systematic review of treatment modalities.Journal of Shoulder and Elbow Surgery. 2008; 17: 42-54
- Treatment preferences for displaced three- and four-part proximal humerus fractures.Journal of Orthopaedic Trauma. 2010; 24: 250-254
- The results of ORIF of displaced unstable proximal humeral fractures using a locking plate.Journal of Shoulder and Elbow Surgery. 2010; 19: 480-488
- Use of locking plates in the treatment of proximal humerus fractures.Journal of Shoulder and Elbow Surgery. 2010; 19: 66-75
- Locking plate technology: current concepts.Journal of Knee Surgery. 2007; 20: 50-55
- Complications encountered in proximal humerus fractures treated with locking plate fixation.Acta Orthopaedica et Traumatologica Turcica. 2010; 44: 89-96
- Pitfalls and complications with locking plate for proximal humerus fracture.Journal of Shoulder and Elbow Surgery. 2010; 19: 489-494
- Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique.Journal of Bone and Joint Surgery. 2010; 92: 85-95
- The importance of medial support in locked plating of proximal humerus fractures.Journal of Orthopaedic Trauma. 2007; 21: 185-191
- The block-bridge system: a new concept and surgical technique to reconstruct articular surfaces and tuberosities in complex proximal humeral fractures.Journal of Shoulder and Elbow Surgery. 2008; 17: 29-36
- Biomechanical analysis of proximal humeral fixation using locking plate fixation with an intramedullary fibular allograft.Clinical Biomechanics (Bristol, Avon). 2010; 25: 642-646
- Fractures of the proximal humerus in osteoporotic bone.Osteoporosis International. 2005; 16: S65-S72
- Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus.Journal of Shoulder and Elbow Surgery. 2004; 13: 427-433
- Operative treatment of severe proximal humeral fractures.Acta Orthopaedica Scandinavica. 1983; 54: 374-379
- Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases.Orthopaedics & Traumatology: Surgery & Research. 2009; 95: 48-55
- Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up.Journal of Bone and Joint Surgery: British Volume. 2007; 89: 516-520
- The clinical relevance of posttraumatic avascular necrosis of the humeral head.Journal of Shoulder and Elbow Surgery. 1998; 7: 586-590
- Post-traumatic avascular necrosis of the humeral head in displaced proximal humeral fractures.Journal of Trauma. 1981; 21: 788-791
- Closed treatment of fractures of the proximal humerus.Acta Orthopaedica Scandinavica. 1984; 55: 48-51
- Results of surgical treatment of multifragmented fractures of the humeral head.Archives of Orthopaedic and Trauma Surgery. 1982; 100: 249-259
- Four-part valgus impacted fractures of the proximal humerus.Journal of Bone and Joint Surgery: British Volume. 1991; 73: 295-298
- Quantitative assessment of the vascularity of the proximal part of the humerus.Journal of Bone and Joint Surgery. 2010; 92: 943-948
- Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study.Journal of Bone and Joint Surgery: British Volume. 1993; 75: 132-136
- Results of proximal humeral locked plating with supplemental suture fixation of rotator cuff.Journal of Shoulder and Elbow Surgery. 2011; 20: 616-624
- Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome.Journal of Orthopaedic Trauma. 2009; 23: 113-119
- Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures.Injury. 2007; 38: S59-S68
- Effect of screw placement on fixation in the humeral head.Journal of Shoulder and Elbow Surgery. 2000; 9: 423-426
- Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant.Journal of Orthopaedic Trauma. 2008; 22: 195-200
- Endosteal strut augment reduces complications associated with proximal humeral locking plates.Clinical Orthopaedics and Related Research. 2011; 469: 3300-3306
- Internal fracture fixation in patients with osteoporosis.Journal of the American Academy of Orthopaedic Surgeons. 2003; 11: 109-119
- Journal of Bone and Joint Surgery. 2002; 84A: 454-464
- Bone grafts and bone graft substitutes in orthopaedic trauma surgery. A critical analysis.Journal of Bone and Joint Surgery. 2007; 89: 649-658
Article info
Publication history
Accepted:
June 25,
2012
Identification
Copyright
© 2012 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
