The potential of locking plate with intramedullary fibular allograft to manage proximal humeral fracture with an unstabl
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ORTHOPAEDIC SURGERY
The potential of locking plate with intramedullary fibular allograft to manage proximal humeral fracture with an unstable medial column Young‑Kyu Kim1 · Suk‑Woong Kang2 · Kyu‑Hak Jung1 · Young‑Kwang Oh2 Received: 1 December 2019 / Accepted: 9 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate the potential of locking compression plate with intramedullary fibular allograft in managing proximal humeral fractures with an unstable medial column. Methods Between March 2007 and March 2015, we retrospectively analyzed 63 patients who underwent locking plate fixation for proximal humeral fracture with an unstable medial column. All patients were assigned into group 1 (patients treated with locking plate) and group 2 (patients treated with locking plate with intramedullary fibular allograft). Groups 1 and 2 were composed of 29 and 34 patients, respectively. We analyzed bone union, the neck–shaft angle, the Constant score, the range of motion, and complications. Results The mean average bone union time of the patients was 13.9 weeks in group 1 and 11.3 weeks in group 2. The average Constant score was 67.4 in group 1 and 73.6 in group 2 (p 65 years with fracture–dislocations or severely comminuted four-part fractures were excluded from the study because of hemiarthroplasty or reverse total shoulder arthroplasty considerations. Since May 2010, fibular allograft has been performed in patients aged > 65 years with a proximal humeral fracture with an unstable medial column. Five of the 68 patients were not followed up for more than 1 year. We retrospectively analyzed 63 patients who underwent locking plate fixation for proximal humeral fracture with an unstable medial column. All patients were divided into group 1 (29 patients treated with locking plate, March 2007–April 2010) and group 2 (34 patients treated with locking plate with intramedullary fibular allograft, May 2010–March 2015). In the control group (group 1), we used only a
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Archives of Orthopaedic and Trauma Surgery
locking plate without allograft or any other specific procedure. Calcar screws were used in both groups. In group 1, the mean age at the time of surgery was 73.8 (range 65–91) years, and the mean follow-up duration was 18.6 (range 12–36) months. In group 2, the mean age at the time of surgery was 76.0 (range 65–90) years, and the mean follow-up duration was 16.2 (range 12–30) months. Using dual-energy X-ray absorptiometry, we measured the bone density of the patients’ hip and spine, which according to the lowest T-score, showed an average bone mineral density of − 2.5 (− 0.8 to − 3.6) in group 1 and − 2.9 (− 1.3 to − 4.6) in group 2 (Table 1). Simple radiography was performed immediately after surgery and at 2 weeks, 4 weeks, 3 months, 6 months, 9 months, and 12 months postoperatively. Successful bone union was defined as a complete bridging of the fracture site through callus formation. Humeral neck–shaft angles (NSAs) were measured in the anteroposterior plane. We defin
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