Is medial calcar continuity necessary in plate osteosynthesis for proximal humerus fractures?

To evaluate the functional and radiological results of patients with and without medial calcar continuity in plate osteosynthesis applied for a proximal humerus fracture retrospectively.

The study included 27 patients to whom plate osteosynthesis was applied because of a proximal humerus fracture between January 2, 2010, and December 30, 2013, at Okmeydanı Research and Training Hospital. Patients were separated into Group A with medial calcar continuity and Group B without medial calcar continuity. On the radiographs taken postoperatively and at the final follow-up examination, measurements were taken of the humeral head height and the humeral neck-shaft angle. The presence of avascular necrosis was recorded.

The functional and radiological results of the patients were evaluated after a mean follow-up of 39.1 months. No statistically significant difference was determined between Groups A and B in respect of the postoperative and the final follow-up humeral head height (P > 0.05). No statistically significant difference was determined between Groups A and B in respect of the postoperative and the final follow-up humeral neck-shaft angle (P > 0.05). Plate breakage was seen in one patient without medial calcar continuity. Penetration of the screw into the joint was determined in one patient in Group A and three patients in Group B. No avascular necrosis or infection was seen in any patient.

When the surgical process has not damaged the soft tissue and sufficient stability has been achieved, providing calcar continuity is not an absolute condition.