TYPE C2 PROXIMAL HUMERAL FRACTURE FIXATION USING LOCKING-PLATE WITH AN INTRAMEDULLARY FIBULAR ALLOGRAFT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENXiaojun ¹ , CHENHongsheng ² ,  ZOUYonggen ¹ , FENGHuirong ¹ , WUJian ¹ , ZHANGJian ¹ , PENGZhongyi ¹

1. Department of Orthopedic Surgery, the Affiliated Hospital of Traditional Chinese Medicine, Luzhou Medical College, Luzhou Sichuan, 646000, P. R. China;
2. Department of Emergency, the Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan, 646000, P. R. China;

Corresponding author：

ZOUYonggen, Email: orthluzhou@163.com

Keywords：

Proximal humeral fracture; Locking-plate; Fibular allograft; Intramedullary support

DOI：

10.7507/1002-1892.20140043

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Objective To investigate the clinical results of locking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation. Methods Between January 2011 and August 2012, 16 patients with proximal humeral fractures (AO type C2) were treated by locking-plate with an intramedullary fibular allograft. The clinical data were retrospectively analysed. There were 5 males and 11 females with an average age of 64 years (range, 55-70 years). The injury causes were falling injury in 12 cases, traffic accident injury in 3 cases, and sports injury in 1 case. The duration between injury and operation ranged from 2 to 6 days (mean, 4.5 days). The imaging data were used to judge the fracture healing, and to measure the neck-shaft angle and the height of humeral head; the disability of arm, shoulder, and hand (DASH) score, short-form 36 health survey scale (SF-36), and Neer score were used to evaluate the function of the shoulder after surgery. Results Primary healing of incision was obtained in all patients; no complication of vascular and nerve injury occurred. Sixteen cases were followed up 12-24 months (mean, 18 months). All fractures healed at 18-24 weeks (mean, 20 weeks). No complication occurred as follows:re-displacement, necrosis, rejection reaction, and loosening or extraction of screws. At last follow-up, the neck-shaft angle was 126.6-136.9° (mean, 132.5°), showing a little lost when compared with intraoperative angle (130.5-138.0°, 134.0° on average). At 12 months after surgery, the height loss of humeral head was 1.8-4.6 mm (mean, 2.0 mm); the passive anteflexion of the shoulder was 130-160° (mean, 148°); the active anteflexion was 120-145° (mean, 136°); the external rotation was 30-65° (mean, 56°); the internal rotation was 15-25° (mean, 19°). And the DASH score was 2-53 (mean, 12); the SF-36 score was 50-95 (mean, 89). According to Neer score for shoulder function, the results were excellent in 10 cases, good in 4 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 87.5%. Conclusion Locking-plate with an intramedullary fibular allograft for type C2 proximal humeral fracture fixation has satisfactory clinical results because of stable fixation, high clinical outcome scores, and low internal fixation failure.

Citation： CHENXiaojun, CHENHongsheng, ZOUYonggen, FENGHuirong, WUJian, ZHANGJian, PENGZhongyi. TYPE C2 PROXIMAL HUMERAL FRACTURE FIXATION USING LOCKING-PLATE WITH AN INTRAMEDULLARY FIBULAR ALLOGRAFT. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(2): 201-204. doi: 10.7507/1002-1892.20140043 Copy

1.	Gaebler C,McQueen MM,Court-Brown CM.Minimally displaced proximal humeral fractures:epidemiology and outcome in 507 cases.Acta Orthop Scand,2003,74(5):580-585.
2.	Neviaser AS,Hettrich CM,Beamer BS,et al.Endosteal strut augment reduces complications associated with proximal humeral locking plates.Clin Orthop Relat Res,2011,469(12):3300-3306.
3.	Martin JS,Marsh JL.Current classification of fractures.Rationale and utility.Radiologic Clinics of North America,1997,35(3):491-506.
4.	Martin J,Kelley BG.Shoulder rehabilitation//Iannotti JP,Williams GR.Disorders of the shoulder:diagnosis and mangement.Philadelphia:Lippinccott Williams&Wilkins,1999:1015-1016.
5.	Sporer SM,Weinstein JN,Koval KJ.The geographic incidence and treatment variation of common fractures of elderly patients.J Am Acad Orthop Surg,2006,14(4):246-255.
6.	Volgas DA,Stannard JP,Alonso JE.Nonunions of the humerus.Clin Orthop Relat Res,2004,(419):46-50.
7.	Solberg BD,Moon CN,Franco DP,et al.Surgical treatment of three and four-part proximal humeral fractures.J Bone Joint Surg (Am),2009,91(7):1689-1697.
8.	Owsley KC,Gorczyca JT.Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures[corrected].J Bone Joint Surg (Am),2008,90(2):233-240.
9.	Thalhammer G,Platzer P,Oberleitner G,et al.Angular stable fixation of proximal humeral fractures.J Trauma,2009,66(1):204-210.
10.	Gardner MJ,Boraiah S,Helfet DL,et al.Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant.J Orthop Trauma,2008,22(3):195-200.
11.	Lee CW,Shin SJ.Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation.J Shoulder Elbow Surg,2009,18(1):83-88.
12.	Matassi F,Angeloni R,Carulli C,et al.Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus.Injury,2012,43(11):1939-1942.
13.	Hettrich CM,Neviaser A,Beamer BS,et al.Locked plating of the proximal humerus using an endosteal implant.J Orthop Trauma,2012,26(4):212-215.
14.	Mathison C,Chaudhary R,Beaupre L,et al.Biomechanical analysis of proximal humeral fixation using locking plate fixation with an intramedullary fibular allograft.Clin Biomech (Bristol,Avon),2010,25(7):642-646.
15.	Berkes MB,Little MT,Lazaro LE,et al.Intramedullary allograft fibula as a reduction and fixation tool for treatment of complex proximal humerus fractures with diaphyseal extension.J Orthop Trauma,2013.[Epub ahead of print].
16.	Chow RM,Begum F,Beaupre LA,et al.Proximal humeral fracture fixation:locking plate construct ±intramedullary fibular allograft.J Shoulder Elbow Surg,2012,21(7):894-901.
17.	Haddad FS,Duncan CP.Cortical onlay allograft struts in the treatment of periprosthetic femoral fractures.Instr Course Lect,2003,52:291-300.
18.	丁真奇,陈长青,翟文亮,等.异体长骨干移植修复四肢骨囊肿合并病理性骨折.中国修复重建外科杂志,2004,18(5):373-375.
19.	Willis MP,Brooks JP,Badman BL,et al.Treatment of atrophic diaphyseal humeral nonunions with compressive locked plating and augmented with an intramedullary strut allograft.J Orthop Trauma,2013,27(2):77-81.

1. Gaebler C,McQueen MM,Court-Brown CM.Minimally displaced proximal humeral fractures:epidemiology and outcome in 507 cases.Acta Orthop Scand,2003,74(5):580-585.
2. Neviaser AS,Hettrich CM,Beamer BS,et al.Endosteal strut augment reduces complications associated with proximal humeral locking plates.Clin Orthop Relat Res,2011,469(12):3300-3306.
3. Martin JS,Marsh JL.Current classification of fractures.Rationale and utility.Radiologic Clinics of North America,1997,35(3):491-506.
4. Martin J,Kelley BG.Shoulder rehabilitation//Iannotti JP,Williams GR.Disorders of the shoulder:diagnosis and mangement.Philadelphia:Lippinccott Williams&Wilkins,1999:1015-1016.
5. Sporer SM,Weinstein JN,Koval KJ.The geographic incidence and treatment variation of common fractures of elderly patients.J Am Acad Orthop Surg,2006,14(4):246-255.
6. Volgas DA,Stannard JP,Alonso JE.Nonunions of the humerus.Clin Orthop Relat Res,2004,(419):46-50.
7. Solberg BD,Moon CN,Franco DP,et al.Surgical treatment of three and four-part proximal humeral fractures.J Bone Joint Surg (Am),2009,91(7):1689-1697.
8. Owsley KC,Gorczyca JT.Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures[corrected].J Bone Joint Surg (Am),2008,90(2):233-240.
9. Thalhammer G,Platzer P,Oberleitner G,et al.Angular stable fixation of proximal humeral fractures.J Trauma,2009,66(1):204-210.
10. Gardner MJ,Boraiah S,Helfet DL,et al.Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant.J Orthop Trauma,2008,22(3):195-200.
11. Lee CW,Shin SJ.Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation.J Shoulder Elbow Surg,2009,18(1):83-88.
12. Matassi F,Angeloni R,Carulli C,et al.Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus.Injury,2012,43(11):1939-1942.
13. Hettrich CM,Neviaser A,Beamer BS,et al.Locked plating of the proximal humerus using an endosteal implant.J Orthop Trauma,2012,26(4):212-215.
14. Mathison C,Chaudhary R,Beaupre L,et al.Biomechanical analysis of proximal humeral fixation using locking plate fixation with an intramedullary fibular allograft.Clin Biomech (Bristol,Avon),2010,25(7):642-646.
15. Berkes MB,Little MT,Lazaro LE,et al.Intramedullary allograft fibula as a reduction and fixation tool for treatment of complex proximal humerus fractures with diaphyseal extension.J Orthop Trauma,2013.[Epub ahead of print].
16. Chow RM,Begum F,Beaupre LA,et al.Proximal humeral fracture fixation:locking plate construct ±intramedullary fibular allograft.J Shoulder Elbow Surg,2012,21(7):894-901.
17. Haddad FS,Duncan CP.Cortical onlay allograft struts in the treatment of periprosthetic femoral fractures.Instr Course Lect,2003,52:291-300.
18. 丁真奇,陈长青,翟文亮,等.异体长骨干移植修复四肢骨囊肿合并病理性骨折.中国修复重建外科杂志,2004,18(5):373-375.
19. Willis MP,Brooks JP,Badman BL,et al.Treatment of atrophic diaphyseal humeral nonunions with compressive locked plating and augmented with an intramedullary strut allograft.J Orthop Trauma,2013,27(2):77-81.

Chinese Journal of Reparative and Reconstructive Surgery

TYPE C2 PROXIMAL HUMERAL FRACTURE FIXATION USING LOCKING-PLATE WITH AN INTRAMEDULLARY FIBULAR ALLOGRAFT

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