Locking plate fixation combined with different bone grafts for Neer 3- and 4-part fractures of proximal humerus in the elderly

doi:10.12307/2021.273

Abstract

Abstract: BACKGROUND: Elderly patients with Neer 3- and 4-part fractures of the proximal humerus have poor proximal bone, so the bone defect after fracture reduction is very serious, which will lead to poor effect of simple locking plate fixation.
OBJECTIVE: To evaluate the efficacy and mechanism of allogeneic ilium and fibula in the treatment of Neer 3- and 4-part fractures of the proximal humerus in the elderly.
METHODS: Data of 64 elderly patients with Neer 3- and 4-part fractures of the proximal humerus and undergoing different surgery techniques in Department of Orthopedics, The First Affiliated Hospital of Shanxi Medical University from November 2014 to March 2019 were retrospectively analyzed. They were divided into three groups: single locking plate (group A, 24 cases), locking plate combined with allogeneic ilium (group B, 19 cases) and locking plate combined with allogeneic fibula (group C, 21 cases). The following observation indexes were compared in three groups: (1) General indicators: operation time, intraoperative blood loss, hospital stay; (2) imaging indicators: the neck-shaft angle, humerus head height, and healing time; (3) efficacy indicators: Constant-Murley score, visual analog scale, the incidence of complications.
RESULTS AND CONCLUSION: (1) All patients were healed and followed up from 12 to 24 months. (2) The operation time and hospital stay in group A were significantly better than those in groups B and C (P < 0.05). However, there was no significant difference in intraoperative blood loss compared with groups B and C (P > 0.05). There was no significant difference in three indicators between groups B and C (P > 0.05). (3) Group A had higher neck-shaft angle and humerus head height than groups B and C (P < 0.05), and there was no significant difference between group B and group C (P > 0.05). There were significant differences in the healing time between groups A, B and C (P < 0.05), in which group A > group C > group B. (4) The total Constant-Murley score and the score of active items in group A were lower than those in groups B and C (P < 0.05), and there was no significant difference between group B and group C (P > 0.05). There was no statistically significant difference in visual analog scale score among groups A, B and C (P > 0.05). (5) Complications in group A included screw resection in 1 case, humeral head necrosis in 1 case, and joint stiffness in 2 cases. There was 1 case of acromial impingement syndrome in group B. In group C, screw resection occurred in 1 case and head necrosis of humerus in 1 case. There was no significant difference in the incidence of complications in the three groups (P > 0.05). (6) It is indicated that locking plate is the first choice for the treatment of Neer 3- and 4-part fractures of the proximal humerus in the elderly. For those with significant bone defects, mechanical stability can be achieved by combining fibula allografts. For partial bone defects, ilium allograft can be used to accelerate osteogenic healing.

Key words: proximal humeral fractures, locking plate, bone transplantation, ilium, fibula, bone graft, fracture, internal fixation

CLC Number:

Liu Wenjie, Yu Lijuan, Xu Bin. Locking plate fixation combined with different bone grafts for Neer 3- and 4-part fractures of proximal humerus in the elderly[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(30): 4851-4856.

Figures/Tables 8

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