Open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with locking plate and intramedullary allograft: A retrospective study

Abstract

Background: This retrospective clinical study aims to compare the functional and radiological outcomes after open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with both locking plate and intramedullary graft.

Methods: Forty-seven patients with proximal humerus fractures were treated with either open reduction and internal fixation (25 cases) or minimally invasive plate osteosynthesis (22 cases) and evaluated retrospectively with a minimum follow-up of 12 months. Thirty-one fresh-frozen fibulae and 16 lyophilized tibia allografts were used for augmentation. Change of both neck-shaft angle and humeral head height were evaluated radiologically. Functional outcomes were assessed using Disabilities of the Arm, Shoulder and Hand Score (DASH), Absolute Constant-Murley Score (CS^abs), Relative Constant-Murley Score (CS^rel), and Individual Relative Constant-Murley Score (CS^indiv).

Results: Follow-up period and age for open reduction and internal fixation/minimally invasive plate osteosynthesis were 27.4 ± 16.2/29.6 ± 17.6 months and 60.5 ± 13.7/66.3 ± 11.7 years. CS^abs, CS^rel, and CS^indiv were 57.3 ± 21.2/52.4 ± 18.9, 73 ± 24.1/73.9 ± 23.4, and 69.6 ± 24.8/64 ± 25.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.409. DASH was 14.8 ± 12.5/18.7 ± 14.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p = 0.324. Decrease of neck-shaft angle and humeral head height was 7.8 ± 9.4/8.2 ± 15.6° and 0.6 ± 5.5/1.4 ± 2.6 mm for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.380. Surgical time was 165.8 ± 77.6/84.7 ± 38.1 min for open reduction and internal fixation/minimally invasive plate osteosynthesis, p < 0.001.

Conclusions: Locked plating with intramedullary graft augmentation of unstable proximal humerus fractures demonstrates similar functional and radiological outcomes when comparing open reduction and internal fixation with minimally invasive plate osteosynthesis. However, minimally invasive plate osteosynthesis is related to significantly shorter surgical time versus open reduction and internal fixation.

Keywords: Proximal humerus; augmentation; intramedullary graft; locking plate; minimally invasive plate osteosynthesis; open reduction and internal fixation.

Figure 1.

Shaping of allograft's diameter.

Figure 2.

Insertion of IMG and temporary fixation with K-wires. IMG: intramedullary graft; K-wires: Kirschner wires.

Figure 3.

Reposition of the humeral head relative to the allograft height and the medial cortex.

Figure 4.

3D-CT reconstruction of unstable PHF with initial varus displacement (a); intraoperative X-rays of the same fracture after LP fixation with IMG in vertical position (b). 3D: three-dimensional; CT: computed tomography; PHF: proximal humerus fracture; LP: locking plate; IMG: intramedullary graft.

Figure 5.

X-rays of a valgus-impacted PHF (a); intraoperative X-rays after MIPO showing an oblique IMG position (b). PHF: proximal humerus fracture; MIPO: minimally invasive plate osteosynthesis; IMG: intramedullary graft.