Comparison of intramedullary fibular allograft with locking compression plate versus shoulder hemi-arthroplasty for repair of osteoporotic four-part proximal humerus fracture: Consecutive, prospective, controlled, and comparative study

• Published in: Orthopaedics & traumatology, surgery & research Vol. 102; no. 3; pp. 287 - 292
• Main Authors: Chen, H, Ji, X, Gao, Y, Zhang, L, Zhang, Q, Liang, X, Tang, P
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.05.2016
• Subjects: Aged; Aged, 80 and over; Bone Plates; Bone Transplantation - instrumentation; Bone Transplantation - methods; Female; Fibula - transplantation; Follow-Up Studies; Four-part proximal humeral fracture; Fracture Fixation, Intramedullary - instrumentation; Fracture Fixation, Intramedullary - methods; Hemiarthroplasty; Humans; Intramedullary fibular allograft; Locking compression plate; Male; Middle Aged; Orthopedics; Osteoporotic Fractures - surgery; Prospective Studies; Shoulder Fractures - surgery; Shoulder hemi-arthroplasty; Surgery; Transplantation, Homologous; Treatment Outcome; Four-part proximal humeral fracture; Shoulder hemi-arthroplasty; Locking compression plate; Intramedullary fibular allograft
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2015.12.021

Abstract Objectives To compare the outcomes of intramedullary fibular allograft (IFA) with locking compression plates (LCPs) versus shoulder hemi-arthroplasty (HA) in osteoporotic four-part proximal humeral fracture (PHF). Methods Between January 2010 and December 2012, totally 60 cases with osteoporotic four-part PHF were enrolled in this study and were randomly separated into IFA and LCPs group and HA group ( n = 30). Additionally, surgery indexes for patients in the two groups, such as Constant-Murley score (CMS), the Disability of Arm, Shoulder and Hand (DASH) score, individual subject evaluation of the outcomes, plain X-ray, and computer tomography (CT) scanning were evaluated and compared. Results CMS, DASH score, activities of daily living (ADL), and range of motion (ROM) were statistically higher in the IFA and LCPs group than those in the HA group at the last follow-up, whereas the pain were obviously lower than that in the HA group. Besides, patients in the IFA and LCPs group had higher abduction, external rotation with elbow, strength, and satisfactory rating compared with HA group at the last follow-up. However, one case developed avascular necrosis (AVN), one case encountered screw perforation, and one case experienced varus displacement in the IFA and LCPs group, while there were 2, 4, and 2 cases suffered from superficial infection, shoulder stiffness, tuberosity migration in the HA group, respectively. Conclusion IFA with LCP have an advantage in functional outcomes than shoulder HA. Level of evidence Level II. Prospective cohort study.