Fibular Autograft as Medial Support with Proximal Humerus Locking Plate Construct in Comminuted Proximal Humerus...

Varus collapse is one of the pivotal mechanisms of failure following surgical fixation of proximal humerus fractures. The aim of the present study was to evaluate functional and radiological outcomes of non-vascularized fibular autograft as medial support with locking plate construct for comminuted proximal humerus fractures (PHF's).

We retrospectively evaluated 18 patients with unstable PHF's in the age group 50-70 years with a minimum follow-up of two years. All the fracture patterns were classified according to Resch, Neer's and AO classification and either medial calcar compromise or comminution were present in all. Open reduction internal fixation (ORIF) with a locking plate was performed for all the patients along with intramedullary fibular autograft to support medial calcar. Radiological outcome was assessed by neck-shaft angle (NSA) graded according to the Paavolainen grading method and difference in the humeral head height (HHH). Functional outcome was assessed by shoulder range of motion (ROM), University of California-Los Angeles (UCLA) score and American shoulder and elbow surgeons score (ASES).

Radiological union at the fracture site was achieved in all the patients at mean of 8 months (range 6-12 months). Range of movements were mean flexion of 123.89, extension 35.28, internal rotation 66.94, external rotation 57.78 and abduction of 115° at final follow-up. The average NSA was in the range of 120°-130° and none of the patients showed difference in HHH of ≥ 4 mm in the immediate post-operative radiograph and that taken on final follow-up. The functional outcome assessed by ASES score (mean 89.44) and UCLA score (mean 29.61) suggested fair to good results. None of the patients has shown varus collapse and avascular necrosis. Neither there were any complications related to the donor area.

In unstable proximal humerus fractures with calcar comminution or void, PHILOS plate fixation augmented with fibular autograft as a medial support reduces varus collapse and promotes early radiological union.