An intramedullary fibular head allograft together with a locking proximal humerus plate fixation for complicated fractures of the proximal humerus in elderly patients

ZHU Jia-liang; YANG Run-gong; WU Ke-jian; ZHONG Hong-bin; ZUO Tan-tan; HOU Shu-xun

doi:10.3969/j.issn.2095-252X.2013.11.008

Abstract：Objective To investigate the effects of a deep-frozen intramedullary fibular head allograft together with a locking proximal humerus plate ( LPHP ) fixation in the treatment of comminuted fractures of the proximal humerus in elderly patients. Methods From January 2010 to June 2012, 15 elderly patients with comminuted fractures of the proximal humerus were treated with a LPHP together with a deep-frozen intramedullary ifbular head allograft. There were 6 males and 9 females, whose mean age was 73 years old ( range;62-85 years ). Fractures were caused by falling in 11 cases and trafifc accidents in 4 cases. All patients had osteoporosis and comminuted fractures, with loss of the medial column mechanical support. As a result, the reduction was relatively dififcult. According to the Neer classiifcation, 7 patients had 3-part fractures and 8 patients had 4-part fractures. Fractures combined with shoulder dislocation occurred in 4 cases. Results The operation time was 60-180 minutes with an average period of 95 minutes. The blood loss was 100-500 ml during the operation with an average amount of 240 ml. All incisions healed by ifrst intention postoperatively, and no early complications such as immunological rejection, infection or neurovascular injuries were found. All patients were followed up for 19 months on average ( range;15-30 months ). Based on the X-ray iflms, all fractures got union, without obvious loss of reduction or fracture displacement, screw ifxation failure or cut-out or humeral head necrosis. According to the Neer shoulder function scoring system, the results were excellent in 13 cases and fair in 2 cases at 1 year after the operation. The excellent and good rate was 86.7%. Conclusions The effects of a deep-frozen intramedullary ifbular head allograft together with a LPHP ifxation were satisfactory in the treatment of comminuted fractures of the proximal humerus in elderly patients.