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Observational Study
. 2021 May 19:27:e928982.
doi: 10.12659/MSM.928982.

Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes

Elias Polykandriotis  1   2 , Annelie Zschiegner  3 , Raymund E Horch  2 , Matthias Schürmann  4
Affiliations
Observational Study

Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes

Elias Polykandriotis et al. Med Sci Monit. .

Abstract

BACKGROUND Early failure of osteosyntheses is common even with use of locking plates. In patients with comminuted fractures and epiphyseal osseous defects, we performed a series of osteosyntheses by locking plate in combination with an allograft bone augmentation. Because of encouraging short-term results in the literature, we assumed that the method could be a potential alternative to a reverse shoulder prosthesis. MATERIAL AND METHODS Twenty-six patients with a dislocated proximal humeral fracture (Neer IV/V/VI) were studied. A lyophilized allogeneic bone graft was used to reinforce the humeral head fragments before locking plate osteosynthesis. The outcomes of fractures were assessed with Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley (Constant) scores, range of motion, a visual analog scale, and with radiological testing. The Constant-Murley scores were the endpoint of our study. RESULTS The Neer classification of the fractures was type IV in 4 patients, type V in 20 patients, and type VI in 2 patients. The mean DASH score was 52.85 (range, 4.17-79.3) and the mean Constant score was 39.26 (range, 17-88). We observed late necrosis of the humeral head in 15 of 24 patients (62.5%), although early radiological follow-up showed that the humeral head had been anatomically reconstructed. CONCLUSIONS Long-term follow-up demonstrated inferior functional results, as displayed by poor Constant scores. There was a high incidence of necrosis, in spite of initial anatomical reconstruction. Biointegration of the allogeneic bone graft and revascularization of the humeral head fragments could be impaired in geriatric patients who have gross dislocation. Therefore, augmentation of the humeral head with allogeneic bone grafts cannot be recommended in these patients.

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Figures

Figure 1
Figure 1
Distribution of Disabilities of the Arm, Shoulder and Hand and Constant-Murley scores displayed as a whisker plot.
Figure 2
Figure 2
No statistically significant correlation was found between the angle of varus malreduction and the Constant or Distribution of Disabilities of the Arm, Shoulder and Hand scores.
Figure 3
Figure 3
As the Neer classification increased, there was a significant increase in the risk of humeral head necrosis.
Figure 4
Figure 4
As the Neer classification increased, the Constant-Murley score decreased, but the effect did not reach statistical significance.
Figure 5
Figure 5
A 56-year-old patient with an avulsion of the coracoid process and a comminuted proximal humeral fracture (Neer V).
Figure 6
Figure 6
A 3-dimensional preoperative reconstruction in the same patient.
Figure 7
Figure 7
Trimming and inset of the lyophilized femoral bone allograft.
Figure 8
Figure 8
Early postoperative X-rays demonstrating a satisfactory reduction.
Figure 9
Figure 9
Because of screw perforation, the hardware had to be removed at 11 months.
Figure 10
Figure 10
Necrosis of the humeral head necrosis was found at the 18-month follow-up. The patient underwent hemiprosthesis surgery.
See this image and copyright information in PMC

References

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