Comparison of three reconstruction techniques for medial column support loss in elderly patients with proximal...

To compare the therapeutic outcomes of lateral locking plate combined with anterior medial support plate, locking plate combined with autogenous iliac bone graft, and simple lateral locking plate in the reconstruction of medial column support loss in elderly patients with proximal humeral fractures.

A retrospective cohort study was conducted to analyze the data of 51 elderly patients with proximal humeral fractures who were admitted to the Orthopedics Department of Zhongshan Hospital affiliated with Dalian University from February 2016 to May 2020 and suffered from medial column support deficiency. 16 males and 35 females; Age (62.4 ± 10.2) years old. 17 cases were treated with lateral locking steel plate combined with anterior medial support steel plate (double plate group), 17 cases were treated with locking steel plate combined with autogenous iliac bone graft (bone graft group), and 17 cases were treated with lateral PHILOS steel plate alone (steel plate group). Compare the hospitalization time, intraoperative blood loss, fracture healing time, neck shaft angle, humeral head loss height, and shoulder joint range of motion (flexion, abduction, external rotation, extension) among three groups of patients at the last follow-up. At the last follow-up, use pain visual analog scale (VAS), American Society of Shoulder and Elbow Surgeons (ASES), disability of the arm, shoulder, and hand (DASH) score, and shoulder joint function Constant Murley score to observe the incidence of complications.

All 51 patients were followed up for 12-26 months (mean 16.8 ± 2.6 months). There was no statistically significant difference in preoperative general information among the three groups of patients (P > 0.05), indicating comparability. The bleeding volume of the three groups was 450.6 ± 13.7 ml, 380.5 ± 15.3 ml, and 280.2 ± 10.3 ml, respectively, and the differences between the two groups were statistically significant (P < 0.05). There was no statistically significant difference in hospitalization time and fracture healing time among the three groups of patients (P > 0.05); at the last follow-up, the neck shaft angles were 132.1° ± 9.8°, 125.3° ± 5.4°, and 120.1° ± 7.5°, respectively, with statistically significant differences between the two groups (P < 0.05). At the last follow-up, the height of humeral head loss was 1.32 mm ± 0.33 mm, 2.04 mm ± 0.56 mm, and 3.12 mm ± 0.85 mm, respectively, with statistically significant differences between the two groups (P < 0.05). At the last follow-up, the range of motion for shoulder flexion was 158.6° ± 12.8°, 149.3° ± 10.5°, and 140.2° ± 11.3°, respectively, with statistically significant differences between the two groups (P < 0.05); The outreach activity degrees were 148.2° ± 10.4°, 140.3° ± 11.5°, and 134.3° ± 12.6°, respectively, and the differences between the two groups were statistically significant (P < 0.05); the external rotation range of motion was 41.2° ± 7.8°, 40.5° ± 6.1°, 39.8° ± 7.4°, and the backward extension range of motion was 36.6° ± 1.2°, 35.8° ± 1.0°, 35.2° ± 1.4°, respectively. There was no statistically significant difference in the comparison between the three groups (P > 0.05). At the last follow-up, there was no statistically significant difference in VAS score, ASES score, DASH score, and Constant Murley score among the three groups (P > 0.05). There were 1, 2, and 3 patients with complications in each of the three groups, respectively, with no statistically significant difference observed among the groups (P > 0.05).

For complex fractures of the proximal humerus in elderly patients with missing medial column support, all three reconstruction techniques can effectively reconstruct the stability of the medial column. However, the combination of a lateral locking plate and an anteromedial support plate (dual plating, Group A) demonstrated superior outcomes in maintaining the postoperative neck shaft angle, prevent loss of humeral head height, improve shoulder joint mobility, promote functional recovery, and have the advantage of fewer complications. However, this technique is also associated with disadvantages such as extensive soft tissue dissection and a relatively complex surgical procedure. Treatment selection should be individualized based on patient factors and surgeon experience.