Application of medial column support in the treatment of proximal humeral fractures_West China Medical Journal

Authors：

CHEN Wei , XING Fei ^共 , DUAN Xin , LIU Ming , CHEN Jialei ,  XIANG Zhou

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

XIANG Zhou, Email: xiangzhou15@hotmail.com

Keywords：

Proximal humeral fractures; Internal fixation with plate and screw; Bone grafting; Bone cement; Supporting screw

DOI：

10.7507/1002-0179.201911177

Video：

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Open reduction and internal fixation with plate and screw is one of the most widely used surgical methods in the treatment of proximal humeral fractures in the elderly. In recent years, more and more studies have shown that it is very important to strengthen the medial column support of the proximal humerus during the surgery. At present, orthopedists often use bone graft, bone cement, medial support screw and medial support plate to strengthen the support of the medial column of the proximal humerus when applying open reduction and internal fixation with plate and screw to treat proximal humeral fractures. Therefore, the methods of strengthening medial column support for proximal humerus fractures and their effects on maintaining fracture reduction, reducing postoperative complications and improving functional activities of shoulder joints after operation are reviewed in this paper. It aims to provide a certain reference for the individualized selection of medial support methods according to the fracture situation in the treatment of proximal humeral fractures.

Citation： CHEN Wei, XING Fei, DUAN Xin, LIU Ming, CHEN Jialei, XIANG Zhou. Application of medial column support in the treatment of proximal humeral fractures. West China Medical Journal, 2021, 36(10): 1424-1428. doi: 10.7507/1002-0179.201911177 Copy

1.	Laux CJ, Grubhofer F, Werner CML, et al. Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res, 2017, 12(1): 137.
2.	Sears BW, Hatzidakis AM, Johnston PS. Intramedullary fixation for proximal humeral fractures. J Am Acad Orthop Surg, 2020, 28(9): e374-e383.
3.	Jung SW, Shim SB, Kim HM, et al. Factors that influence reduction loss in proximal humerus fracture surgery. J Orthop Trauma, 2015, 29(6): 276-282.
4.	Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury, 2011, 42(11): 1283-1288.
5.	De Long WG Jr, Einhorn TA, Koval K, et al. Bone grafts and bone graft substitutes in orthopaedic trauma surgery. A critical analysis. J Bone Joint Surg Am, 2007, 89(3): 649-658.
6.	Kim SH, Lee YH, Chung SW, et al. Outcomes for four-part proximal humerus fractures treated with a locking compression plate and an autologous iliac bone impaction graft. Injury, 2012, 43(10): 1724-1731.
7.	Zhu L, Liu Y, Yang Z, et al. Locking plate fixation combined with iliac crest bone autologous graft for proximal humerus comminuted fracture. Chin Med J (Engl), 2014, 127(9): 1672-1676.
8.	Chow RM, Begum F, Beaupre LA, et al. Proximal humeral fracture fixation: locking plate construct ± intramedullary fibular allograft. J Shoulder Elbow Surg, 2012, 21(7): 894-901.
9.	Mathison C, Chaudhary R, Beaupre L, et al. Biomechanical analysis of proximal humeral fixation using locking plate fixation with an intramedullary fibular allograft. Clin Biomech (Bristol, Avon), 2010, 25(7): 642-646.
10.	Chen H, Ji X, Gao Y, et al. 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. Orthop Traumatol Surg Res, 2016, 102(3): 287-292.
11.	Lee SH, Han SS, Yoo BM, et al. Outcomes of locking plate fixation with fibular allograft augmentation for proximal humeral fractures in osteoporotic patients: comparison with locking plate fixation alone. Bone Joint J, 2019, 101-B(3): 260-265.
12.	Hinds RM, Garner MR, Tran WH, et al. Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation. J Shoulder Elbow Surg, 2015, 24(6): 889-896.
13.	Panchal K, Jeong JJ, Park SE, et al. Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft. Int Orthop, 2016, 40(3): 569-577.
14.	Zhai Q, Han F, He Z, et al. The “magnesium sacrifice” strategy enables PMMA bone cement partial biodegradability and osseointegration potential. Int J Mol Sci, 2018, 19(6): 1746.
15.	Kwon BK, Goertzen DJ, O'Brien PJ, et al. Biomechanical evaluation of proximal humeral fracture fixation supplemented with calcium phosphate cement. J Bone Joint Surg Am, 2002, 84(6): 951-961.
16.	Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures. J Bone Joint Surg Am, 2004, 86(Supp l): 143-155.
17.	Egol KA, Sugi MT, Ong CC, et al. Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures. J Shoulder Elbow Surg, 2012, 21(6): 741-748.
18.	Hengg C, Nijs S, Klopfer T, et al. Cement augmentation of the proximal humerus internal locking system in elderly patients: a multicenter randomized controlled trial. Arch Orthop Trauma Surg, 2019, 139(7): 927-942.
19.	Fletcher JWA, Windolf M, Richards RG, et al. Screw configuration in proximal humerus plating has a significant impact on fixation failure risk predicted by finite element models. J Shoulder Elbow Surg, 2019, 28(9): 1816-1823.
20.	Kim DS, Lee DH, Chun YM, et al. Which additional augmented fixation procedure decreases surgical failure after proximal humeral fracture with medial comminution: fibular allograft or inferomedial screws?. J Shoulder Elbow Surg, 2018, 27(10): 1852-1858.
21.	Zhang X, Huang J, Zhao L, et al. Inferomedial cortical bone contact and fixation with calcar screws on the dynamic and static mechanical stability of proximal humerus fractures. J Orthop Surg Res, 2019, 14(1): 1.
22.	Ponce BA, Thompson KJ, Raghava P, et al. The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates. J Bone Joint Surg Am, 2013, 95(16): e113(1-7).
23.	Fletcher JWA, Windolf M, Grünwald L, et al. The influence of screw length on predicted cut-out failures for proximal humeral fracture fixations predicted by finite element simulations. Arch Orthop Trauma Surg, 2019, 139(8): 1069-1074.
24.	Zeng LQ, Zeng LL, Jiang YW, et al. Influence of medial support screws on the maintenance of fracture reduction after locked plating of proximal humerus fractures. Chin Med J (Engl), 2018, 131(15): 1827-1833.
25.	Zhang L, Zheng J, Wang W, et al. The clinical benefit of medial support screws in locking plating of proximal humerus fractures: a prospective randomized study. Int Orthop, 2011, 35(11): 1655-1661.
26.	Bai L, Fu Z, An S, et al. Effect of calcar screw use in surgical neck fractures of the proximal humerus with unstable medial support: a biomechanical study. J Orthop Trauma, 2014, 28(8): 452-457.
27.	Beirer M, Crönlein M, Venjakob AJ, et al. Additional calcar support using a blade device reduces secondary varus displacement following reconstruction of the proximal humerus: a prospective study. Eur J Med Res, 2015, 20: 82.
28.	He Y, He J, Wang F, et al. Application of additional medial plate in treatment of proximal humeral fractures with unstable medial column: a finite element study and clinical practice. Medicine (Baltimore), 2015, 94(41): e1775.
29.	Hessmann MH, Korner J, Hofmann A, et al. Angle-fixed plate fixation or double-plate osteosynthesis in fractures of the proximal humerus: a biomechanical study. Biomed Tech (Berl), 2008, 53(3): 130-137.
30.	Meyer C, Alt V, Hassanin H, et al. The arteries of the humeral head and their relevance in fracture treatment. Surg Radiol Anat, 2005, 27(3): 232-237.
31.	王礼宁, 王强, 沈婧鈺, 等. 三种手术方式治疗Neer Ⅲ-Ⅳ部分肱骨近端骨折的比较. 中国矫形外科杂志, 2018, 26(22): 2038-2043.
32.	Neviaser AS, Hettrich CM, Dines JS, et al. Rate of avascular necrosis following proximal humerus fractures treated with a lateral locking plate and endosteal implant. Arch Orthop Trauma Surg, 2011, 131(12): 1617-1622.

1. Laux CJ, Grubhofer F, Werner CML, et al. Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res, 2017, 12(1): 137.
2. Sears BW, Hatzidakis AM, Johnston PS. Intramedullary fixation for proximal humeral fractures. J Am Acad Orthop Surg, 2020, 28(9): e374-e383.
3. Jung SW, Shim SB, Kim HM, et al. Factors that influence reduction loss in proximal humerus fracture surgery. J Orthop Trauma, 2015, 29(6): 276-282.
4. Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury, 2011, 42(11): 1283-1288.
5. De Long WG Jr, Einhorn TA, Koval K, et al. Bone grafts and bone graft substitutes in orthopaedic trauma surgery. A critical analysis. J Bone Joint Surg Am, 2007, 89(3): 649-658.
6. Kim SH, Lee YH, Chung SW, et al. Outcomes for four-part proximal humerus fractures treated with a locking compression plate and an autologous iliac bone impaction graft. Injury, 2012, 43(10): 1724-1731.
7. Zhu L, Liu Y, Yang Z, et al. Locking plate fixation combined with iliac crest bone autologous graft for proximal humerus comminuted fracture. Chin Med J (Engl), 2014, 127(9): 1672-1676.
8. Chow RM, Begum F, Beaupre LA, et al. Proximal humeral fracture fixation: locking plate construct ± intramedullary fibular allograft. J Shoulder Elbow Surg, 2012, 21(7): 894-901.
9. Mathison C, Chaudhary R, Beaupre L, et al. Biomechanical analysis of proximal humeral fixation using locking plate fixation with an intramedullary fibular allograft. Clin Biomech (Bristol, Avon), 2010, 25(7): 642-646.
10. Chen H, Ji X, Gao Y, et al. 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. Orthop Traumatol Surg Res, 2016, 102(3): 287-292.
11. Lee SH, Han SS, Yoo BM, et al. Outcomes of locking plate fixation with fibular allograft augmentation for proximal humeral fractures in osteoporotic patients: comparison with locking plate fixation alone. Bone Joint J, 2019, 101-B(3): 260-265.
12. Hinds RM, Garner MR, Tran WH, et al. Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation. J Shoulder Elbow Surg, 2015, 24(6): 889-896.
13. Panchal K, Jeong JJ, Park SE, et al. Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft. Int Orthop, 2016, 40(3): 569-577.
14. Zhai Q, Han F, He Z, et al. The “magnesium sacrifice” strategy enables PMMA bone cement partial biodegradability and osseointegration potential. Int J Mol Sci, 2018, 19(6): 1746.
15. Kwon BK, Goertzen DJ, O'Brien PJ, et al. Biomechanical evaluation of proximal humeral fracture fixation supplemented with calcium phosphate cement. J Bone Joint Surg Am, 2002, 84(6): 951-961.
16. Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures. J Bone Joint Surg Am, 2004, 86(Supp l): 143-155.
17. Egol KA, Sugi MT, Ong CC, et al. Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures. J Shoulder Elbow Surg, 2012, 21(6): 741-748.
18. Hengg C, Nijs S, Klopfer T, et al. Cement augmentation of the proximal humerus internal locking system in elderly patients: a multicenter randomized controlled trial. Arch Orthop Trauma Surg, 2019, 139(7): 927-942.
19. Fletcher JWA, Windolf M, Richards RG, et al. Screw configuration in proximal humerus plating has a significant impact on fixation failure risk predicted by finite element models. J Shoulder Elbow Surg, 2019, 28(9): 1816-1823.
20. Kim DS, Lee DH, Chun YM, et al. Which additional augmented fixation procedure decreases surgical failure after proximal humeral fracture with medial comminution: fibular allograft or inferomedial screws?. J Shoulder Elbow Surg, 2018, 27(10): 1852-1858.
21. Zhang X, Huang J, Zhao L, et al. Inferomedial cortical bone contact and fixation with calcar screws on the dynamic and static mechanical stability of proximal humerus fractures. J Orthop Surg Res, 2019, 14(1): 1.
22. Ponce BA, Thompson KJ, Raghava P, et al. The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates. J Bone Joint Surg Am, 2013, 95(16): e113(1-7).
23. Fletcher JWA, Windolf M, Grünwald L, et al. The influence of screw length on predicted cut-out failures for proximal humeral fracture fixations predicted by finite element simulations. Arch Orthop Trauma Surg, 2019, 139(8): 1069-1074.
24. Zeng LQ, Zeng LL, Jiang YW, et al. Influence of medial support screws on the maintenance of fracture reduction after locked plating of proximal humerus fractures. Chin Med J (Engl), 2018, 131(15): 1827-1833.
25. Zhang L, Zheng J, Wang W, et al. The clinical benefit of medial support screws in locking plating of proximal humerus fractures: a prospective randomized study. Int Orthop, 2011, 35(11): 1655-1661.
26. Bai L, Fu Z, An S, et al. Effect of calcar screw use in surgical neck fractures of the proximal humerus with unstable medial support: a biomechanical study. J Orthop Trauma, 2014, 28(8): 452-457.
27. Beirer M, Crönlein M, Venjakob AJ, et al. Additional calcar support using a blade device reduces secondary varus displacement following reconstruction of the proximal humerus: a prospective study. Eur J Med Res, 2015, 20: 82.
28. He Y, He J, Wang F, et al. Application of additional medial plate in treatment of proximal humeral fractures with unstable medial column: a finite element study and clinical practice. Medicine (Baltimore), 2015, 94(41): e1775.
29. Hessmann MH, Korner J, Hofmann A, et al. Angle-fixed plate fixation or double-plate osteosynthesis in fractures of the proximal humerus: a biomechanical study. Biomed Tech (Berl), 2008, 53(3): 130-137.
30. Meyer C, Alt V, Hassanin H, et al. The arteries of the humeral head and their relevance in fracture treatment. Surg Radiol Anat, 2005, 27(3): 232-237.
31. 王礼宁, 王强, 沈婧鈺, 等. 三种手术方式治疗Neer Ⅲ-Ⅳ部分肱骨近端骨折的比较. 中国矫形外科杂志, 2018, 26(22): 2038-2043.
32. Neviaser AS, Hettrich CM, Dines JS, et al. Rate of avascular necrosis following proximal humerus fractures treated with a lateral locking plate and endosteal implant. Arch Orthop Trauma Surg, 2011, 131(12): 1617-1622.

West China Medical Journal

Application of medial column support in the treatment of proximal humeral fractures

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