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Patel R, Brown JR, Miles JW, Dornan GJ, Bartolomei C, Dey Hazra RO, Vidal LB, Millett PJ. Preventing varus collapse in proximal humerus fracture fixation: 90-90 dual plating versus endosteal fibular allograft strut. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04738-1. [PMID: 36598604 DOI: 10.1007/s00402-022-04738-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Screw cut out and varus collapse are the most common complication of locked plate fixation of proximal humerus fractures. The purpose of this study was to compare dual plating and endosteal fibular allograft struts as augmentation strategies to prevent varus collapse. MATERIALS AND METHODS A trapezoidal osteotomy was created at the metaphysis to create a 2-part proximal humerus model in 18 paired shoulder specimens. Each specimen was assigned to group A, B, or C and was fixed with either a lateral locking plate, a lateral locking plate and anterior one-third tubular plate in an orthogonal 90/90 configuration, or a lateral locking plate with intramedullary fibular strut, respectively. The specimens were stressed in axial compression to failure. Displacement, elastic limit, ultimate load, and stiffness were recorded and calculated. RESULTS There was no difference in mean cyclic displacement between the three groups (0.71 mm vs 0.89 mm vs 0.61 mm for Group A, B, C, respectively). Lateral plating demonstrated the greatest absolute and relative displacement at the elastic limit (5.3 mm ± 1.5 and 4.4 mm ± 1.3) without significance. The elastic limit or yield point was greatest for fibular allograft, Group C (1223 N ± 501 vs 1048 N ± 367 for Group B and 951 N ± 249 for Group A) without significance. CONCLUSIONS Dual plating of proximal humerus fractures in a 90-90 configuration demonstrates similar biomechanical properties as endosteal fibular strut allograft. Both strategies demonstrate superior stiffness to isolated lateral locked plating.
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Affiliation(s)
- Ravi Patel
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Ste 1000, Vail, CO, 81657, USA
| | - Justin R Brown
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Ste 1000, Vail, CO, 81657, USA
| | - Jon W Miles
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Ste 1000, Vail, CO, 81657, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Ste 1000, Vail, CO, 81657, USA
| | | | - Rony-Orijit Dey Hazra
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Ste 1000, Vail, CO, 81657, USA
| | - Leslie B Vidal
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Ste 1000, Vail, CO, 81657, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Ste 1000, Vail, CO, 81657, USA.
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Role of Fibular Allograft in Proximal Humerus Fractures: A Systematic Review. J Orthop Trauma 2022; 36:e425-e430. [PMID: 35580343 DOI: 10.1097/bot.0000000000002404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To analyze the outcomes and complication rates of fibular allografts (FA) as an augmentation technique for proximal humeral fractures and determine their appropriate indications. DATA SOURCES English- and Spanish-language articles in PubMed, MEDLINE, Embase, Web of Science (Core Collection), and Google Scholar databases were systematically reviewed with the Preferred Reporting Items for Systematic Reviews guidelines on April 10, 2020. STUDY SELECTION Studies of patients with proximal humeral fractures treated primarily with FA and locking compression plates and with a minimum follow-up of 6 months were included, and presenting results with standardized clinical scales, radiological values, and operative complications. DATA EXTRACTION Two authors independently extracted data from the selected studies with a standardized data collection form. Subsequently, each extracted data set was consolidated on the agreement of authors. DATA SYNTHESIS From the initial screening of 361 articles, 5 case series and 6 retrospective cohort studies were included. A meta-analysis was not performed. CONCLUSIONS FA improved the clinical and radiological results, thereby reducing complications. The optimal indication for this procedure may be a 4-part fracture with medial column disruption in younger adults. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Dasari SP, Kerzner B, Fortier LM, Rea PM, Bodendorfer BM, Chahla J, Garrigues GE, Verma NN. Improved outcomes for proximal humerus fracture open reduction internal fixation augmented with a fibular allograft in elderly patients: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:884-894. [PMID: 34906682 DOI: 10.1016/j.jse.2021.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, no meta-analysis has been performed on the efficacy of fibular allograft augmentation for the management of proximal humerus fractures. The purpose of this study was to evaluate the radiographic and clinical outcomes of proximal humerus fractures treated with a locking compression plate (LCP) with or without fibular allograft augmentation. METHODS The Cochrane Database of Systematic Reviews, the Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, and SCOPUS were queried in June of 2021 for literature comparing the radiographic and clinical outcomes for patients with proximal humerus fractures that were treated with an LCP only or an LCP augmented with a fibular allograft. Data describing study design, level of evidence, demographic information, final follow-up, radiographic changes in humeral head height (HHH), radiographic changes in neck shaft angle (NSA), final American Shoulder and Elbow Surgeons (ASES) scores, final Constant-Murley scores, and major complications were collected. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A meta-analysis was performed using pooled weighted mean differences (WMD) to compare changes in HHH, NSA, final ASES and final Constant-Murley scores between the 2 groups; a pooled odds ratio (OR) was used to compare complications between the groups. RESULTS Ten studies with a total of 802 patients were identified. There was a significant difference that favored patients augmented with a fibular allograft for change in HHH (WMD = -2.40; 95% confidence interval [CI], -2.49 to -2.31; P < .00001), change in NSA (WMD = -5.71; 95% CI, -6.69 to -4.72; P < .00001), final ASES scores (WMD = 5.08; 95% CI, 3.69-6.48; P < .00001), and OR for developing a major complication (OR = 0.37; 95% CI, 0.23-0.59; P < .0001). There was no significant difference in final Constant-Murley scores (WMD = 3.36; 95% CI, -0.21 to 6.93; P = .06) or revision surgery rate (P = .182) between the 2 groups. CONCLUSION The pooled WMD and prediction interval suggest that 95% of patients with proximal humerus fractures treated with an LCP augmented with a fibular allograft will have improved radiographic outcomes, improved ASES clinical outcome scores, and decreased odds of a major complication when compared with patients treated with an LCP alone. Limitations of this study include a relatively short average final follow-up time (<2 years) and a potential lack of standardization for radiographic outcomes among included studies.
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Affiliation(s)
- Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Benjamin Kerzner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Luc M Fortier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Parker M Rea
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Blake M Bodendorfer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Skura B, Glazier MT, Schuette HB, Passias BJ, Chang IR, Verre J, Mehta S, Taylor BC. The Corkscrew Technique for Removing a Fibular Strut Allograft From the Proximal Humerus. Cureus 2022; 14:e23233. [PMID: 35449668 PMCID: PMC9012660 DOI: 10.7759/cureus.23233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/05/2022] Open
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Mease SJ, Kraeutler MJ, Gonzales-Luna DC, Gregory JM, Gardner MJ, Choo AM. Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures. J Bone Joint Surg Am 2021; 103:829-836. [PMID: 33617160 DOI: 10.2106/jbjs.20.00665] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Multiple studies comparing nonoperative and operative treatment for displaced proximal humeral fractures in the geriatric population have demonstrated minimal differences in functional outcomes. Factors such as surgeon experience as well as the quality and maintenance of the reduction may influence operative outcomes, and their impact on these findings merits further investigation. ➤ In the treatment of 2 and 3-part fractures involving the surgical neck, intramedullary nailing has demonstrated functional outcomes that are comparable with those of open reduction and internal fixation (ORIF). ➤ In the geriatric population, reverse total shoulder arthroplasty has demonstrated improved functional outcomes, with a decreased rate of reoperation, compared with hemiarthroplasty. Tuberosity repair has been shown to improve functional outcomes and range of motion after both procedures and should be performed at the time of arthroplasty. ➤ Several authors have demonstrated the negative effect of osteopenia on outcomes after ORIF of proximal humeral fractures. Augmentative procedures, including cortical strut augmentation, are being investigated to address this issue; their role in the treatment of these fractures is unclear at this time.
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Affiliation(s)
- Samuel J Mease
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
| | - Daniel C Gonzales-Luna
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - James M Gregory
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Andrew M Choo
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
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Chang Z, Zhang W, Tang P, Chen H. [Research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:375-380. [PMID: 33719248 DOI: 10.7507/1002-1892.202009127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the literature about the clinical application and research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures, and to provide reference for clinical treatment. Methods The literature concerning medial support augmentation of plate osteosynthesis for proximal humeral fractures in recent years was extensively reviewed, as well as the biomechanical benefit and clinical advantage were analyzed thoroughly. Results Medial support augmentation of plate osteosynthesis for proximal humeral fractures is very important, especially in osteoporotic and/or comminuted fractures. Many medial support augmentation methods have been proposed which can be divided into extramedullary support and intramedullary support. It can also be divided into autogenous bone support and allogenic bone support according to the material and source, divided into medial column support, calcar support, and humeral head support according to the support site, and divided into fibular shaft support, femoral head support, anatomic fibula support according to the shape of the augmented fixation. At present, clinical and biomechanical researches show that medial support augmentation is an effective treatment for proximal humeral fractures. Conclusion As an important treatment strategy for the treatment of proximal humeral fractures, the medial support augmentation of plate osteosynthesis gets the focus from the biomechanical studies and clinical treatment. However, there are still widespread controversies among orthopedic surgeons regarding the support mode, site, implant shape, and material of medial column support for augmentation of proximal humeral fractures. More high-quality clinical trials and biomechanical researches as well as multi-disciplinary integration, are needed to provide better strategy treatment for the treatment of proximal humeral fractures.
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Affiliation(s)
- Zuhao Chang
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Wei Zhang
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
| | - Hua Chen
- Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China
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