Functional Outcomes of Proximal Humeral Fracture Fixation Using a Proximal Humerus Internal Locking Osteosynthesis...

Area of Science:

• Orthopedic Surgery
• Traumatology

Background:

• Proximal humerus fractures (PHFs) are common, particularly in the elderly, often resulting from low-energy trauma.
• Plate osteosynthesis is the standard treatment for displaced PHFs, but medial calcar support is crucial for success.
• Medial calcar comminution and osteoporosis can lead to fixation failure in PHFs.

Purpose of the Study:

• To evaluate the efficacy of adding a fibular strut autograft to PHILOS plating for treating proximal humerus fractures.
• To assess the impact of this augmentation on radiological and functional outcomes in patients with medial calcar comminution and osteoporosis.

Main Methods:

• A retrospective review of 12 months of patient data was conducted.
• Included were patients with three- or four-part PHFs, osteoporosis, and medial calcar comminution.
• Patients underwent PHILOS plating with fibular autograft, followed by radiological and functional outcome assessments.

Main Results:

• All 13 included patients achieved fracture union, with an average time to union of 5.2 months.
• Significant improvements were observed in Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and visual analog scale (VAS) scores at one year.
• Radiological evaluation showed anatomical reduction in all fractures, with one case of mild varus alignment.

Conclusions:

• The addition of a fibular strut autograft effectively augments PHILOS plating for proximal humerus fractures with medial calcar comminution.
• This surgical approach leads to good functional outcomes and a low complication rate.
• Fibular strut grafting is a valuable technique for enhancing stability and promoting union in complex PHFs.