Research progress in treatment of proximal humeral fracture with fibular allograft and locking plate_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XING Fei , DUAN Xin , LIU Ming , HUANG Fuguo ,  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：

Fibular allograft; proximal humeral fracture; locking plate; neck-shaft angle

DOI：

10.7507/1002-1892.201906104

Video：

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Objective To review the research progress in the treatment of proximal humeral fractures with fibular allograft and locking plate.Methods The literature about the treatment of proximal humeral fractures with fibular allograft and locking plate was reviewed and analyzed from the aspects such as the biomechanics, imaging prognosis, and clinical prognosis.Results Fibular allograft and locking plate can provide effective medial support for proximal humeral fracture and increase the strength of internal fixation system. Compared with locking plate, fibular allograft combined with locking plate can maintain better humeral neck-shaft angle and the humeral head height after operation in the treatment of proximal humeral fractures, and has better shoulder mobility and shoulder joint function, and does not increase the risk of complications.Conclusion Fibular allograft combined with locking plate may be a new and effective treatment for proximal humeral fractures. However, the long-term follow-up results are insufficient, the final outcome of fibula is uncertain, and the long-term potential adverse reactions caused by this treatment are still indefinite.

Citation： XING Fei, DUAN Xin, LIU Ming, HUANG Fuguo, XIANG Zhou. Research progress in treatment of proximal humeral fracture with fibular allograft and locking plate. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(2): 260-265. doi: 10.7507/1002-1892.201906104 Copy

1.	Südkamp N, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg (Am), 2009, 91(6): 1320-1328.
2.	Sproul RC, Iyengar JJ, Devcic Z, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury, 2011, 42(4): 408-413.
3.	Gardner MJ, Weil Y, Barker JU, et al. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma, 2007, 21(3): 185-191.
4.	Padegimas EM, Zmistowski B, Lawrence C, et al. Defining optimal calcar screw positioning in proximal humerus fracture fixation. J Shoulder Elbow Surg, 2017, 26(11): 1931-1937.
5.	Somasundaram K, Huber C, Babu V, et al. Proximal humeral fractures: the role of calcium sulphate augmentation and extended deltoid splitting approach in internal fixation using locking plates. Injury, 2013, 44(4): 481-487.
6.	Schliemann B, Wähnert D, Theisen C, et al. How to enhance the stability of locking plate fixation of proximal humerus fractures? An overview of current biomechanical and clinical data Injury, 2015, 46(7): 1207-1214.
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.	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.
9.	Gardner MJ, Boraiah S, Helfet DL, et al. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma, 2008, 22(3): 195-200.
10.	石金柱, 黄强, 张玉富. 解剖锁定钢板结合异体腓骨髓腔内结构植骨治疗复杂肱骨近端骨折. 中华肩肘外科电子杂志, 2017, 5(4): 272-277.
11.	陈孝均, 王亮, 牟晓庆, 等. 锁定钢板固定联合异体腓骨髓内移植治疗老年肱骨近端Ⅲ、Ⅳ部分骨折的临床疗效分析. 创伤外科杂志, 2014, 16(4): 339-343.
12.	王永康. Philos 钢板联合异体腓骨治疗 Neer Ⅳ型肱骨近端骨折的疗效分析. 中国医药指南, 2017, 15(21): 128-129.
13.	朱加亮, 杨润功, 吴克俭, 等. 肱骨近端锁定钢板结合同种异体腓骨头髓腔植入治疗老年粉碎性肱骨近端骨折. 中国骨与关节杂志, 2013, 2(11): 632-636.
14.	翁蔚宗, 张军, 曹烈虎, 等. 采用同种异体腓骨植骨重建肱骨近端内侧柱的临床应用及疗效. 现代生物医学进展, 2017, 17(5): 844-848.
15.	朱正国, 齐红哲, 常祖豪, 等. 解剖型异体腓骨髓内支撑钢板内固定术治疗老年肱骨近端粉碎性骨折疗效观察. 解放军医学院学报, 2018, 39(2): 91-94.
16.	熊家伟, 苏维敏, 梁杰, 等. 同种异体腓骨段髓内移植并钢板锁定固定治疗肱骨近端 Neer Ⅲ、Ⅳ型骨折的可行性分析. 中国医学装备, 2017, 14(7): 103-106.
17.	何继业, 张家红, 王栋梁. 锁定钢板结合腓骨植骨治疗骨质疏松性肱骨近端骨折的疗效分析. 中国临床医生杂志, 2016, 44(6): 35-37.
18.	朱炼, 王博, 赵昌平, 等. 锁定钢板结合同种异体髂骨移植与腓骨移植治疗肱骨近端粉碎性骨折的对比研究. 河北医科大学学报, 2017, 38(4): 395-398.
19.	张硕, 汪秋柯, 陈云丰, 等. 锁定钢板结合异体腓骨治疗头内翻型肱骨近端骨折. 中华肩肘外科电子杂志, 2018, 6(1): 19-24.
20.	Hepp P, Lill H, Bail H, et al. Where should implants be anchored in the humeral head? Clin Orthop Relat Res, 2003, (415): 139-147.
21.	Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury, 2011, 42(11): 1283-1288.
22.	朱正国, 常祖豪, 齐红哲, 等. 解剖型腓骨髓内支撑锁定钢板固定肱骨近端骨折的有限元分析. 解放军医学院学报, 2019, 40(1): 62-67.
23.	Osterhoff G, Baumgartner D, Favre P, et al. Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone. J Shoulder Elbow Surg, 2011, 20(5): 740-746.
24.	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.
25.	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.
26.	Bae JH, Oh JK, Chon CS, et al. The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. J Bone Joint Surg (Br), 2011, 93(7): 937-941.
27.	Lescheid J, Zdero R, Shah S, et al. The biomechanics of locked plating for repairing proximal humerus fractures with or without medial cortical support. J Trauma, 2010, 69(5): 1235-1242.
28.	Agudelo J, Schürmann M, Stahel P, et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma, 2007, 21(10): 676-681.
29.	Chen H, Yin P, Wang S, et al. The augment of the stability in locking compression plate with intramedullary fibular allograft for proximal humerus fractures in elderly people. Biomed Res Int, 2018, 2018: 3130625.
30.	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.
31.	Lee S, Han S, Yoo B, 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.
32.	Little MT, Berkes MB, Schottel PC, et al. The impact of preoperative coronal plane deformity on proximal humerus fixation with endosteal augmentation. J Orthop Trauma, 2014, 28(6): 338-347.
33.	潘俊曦, 陈柏行, 陈浩, 等. 经皮微创内固定结合重建内侧柱治疗肱骨近端骨折疗效分析. 实用骨科杂志, 2018, 24(9): 833-836.
34.	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.
35.	常祖豪, 朱正国, 齐红哲, 等. 锁定钢板结合异体腓骨治疗老年肱骨近端粉碎性骨折的中远期疗效观察. 解放军医学院学报, 2019, 40(2): 106-112.
36.	Hayes K, Walton JR, Szomor ZL, et al. Reliability of five methods for assessing shoulder range of motion. Australian J Physiother, 2001, 47(4): 289-294.
37.	Hudak PL, Amadio PC, Bombardier C, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med, 1996, 29(6): 602-608.
38.	Conboy VB, Morris RW, Kiss J, et al. An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg (Br), 1996, 78(2): 229-232.
39.	Marchese C, Cristalli G, Pichi B, et al. Italian cross-cultural adaptation and validation of three different scales for the evaluation of shoulder pain and dysfunction after neck dissection: University of California-Los Angeles (UCLA) Shoulder Scale, Shoulder Pain and Disability Index (SPADI) and Simple Shoulder Test (SST). Acta Otorhinolaryngol Ital, 2012, 32(1): 12-17.
40.	张保焜, 刘敬文, 丁坚, 等. 异体腓骨辅助解剖复位对肱骨近端骨折预后的影响. 上海医学, 2017, 40(6): 359-362.
41.	Chen H, Ji X, Zhang Q, et al. Clinical outcomes of allograft with locking compression plates for elderly four-part proximal humerus fractures. J Orthop Surg Res, 2015, 10: 114.
42.	Matassi F, Angeloni R, Carulli C, et al. Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus. Injury, 2012, 43(11): 1939-1942.
43.	唐佶颖, 陶忠亮, 李军, 等. 同期和延期修复肱骨近端骨折合并的肩袖全层破裂疗效比较. 中国修复重建外科杂志, 2019, 33(9): 1141-1146.
44.	李文庆, 张作君, 刘云龙. 肱骨近端脱套样骨折治疗体会. 中国修复重建外科杂志, 2018, 32(12): 1540-1544.
45.	Hertel R. Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int, 2005, 16(Suppl 2): S65-72.
46.	Kannus P, Palvanen M, Niemi S, et al. Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium. Acta Orthop Scand, 2000, 71(5): 465-470.

1. Südkamp N, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg (Am), 2009, 91(6): 1320-1328.
2. Sproul RC, Iyengar JJ, Devcic Z, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury, 2011, 42(4): 408-413.
3. Gardner MJ, Weil Y, Barker JU, et al. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma, 2007, 21(3): 185-191.
4. Padegimas EM, Zmistowski B, Lawrence C, et al. Defining optimal calcar screw positioning in proximal humerus fracture fixation. J Shoulder Elbow Surg, 2017, 26(11): 1931-1937.
5. Somasundaram K, Huber C, Babu V, et al. Proximal humeral fractures: the role of calcium sulphate augmentation and extended deltoid splitting approach in internal fixation using locking plates. Injury, 2013, 44(4): 481-487.
6. Schliemann B, Wähnert D, Theisen C, et al. How to enhance the stability of locking plate fixation of proximal humerus fractures? An overview of current biomechanical and clinical data Injury, 2015, 46(7): 1207-1214.
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. 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.
9. Gardner MJ, Boraiah S, Helfet DL, et al. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma, 2008, 22(3): 195-200.
10. 石金柱, 黄强, 张玉富. 解剖锁定钢板结合异体腓骨髓腔内结构植骨治疗复杂肱骨近端骨折. 中华肩肘外科电子杂志, 2017, 5(4): 272-277.
11. 陈孝均, 王亮, 牟晓庆, 等. 锁定钢板固定联合异体腓骨髓内移植治疗老年肱骨近端Ⅲ、Ⅳ部分骨折的临床疗效分析. 创伤外科杂志, 2014, 16(4): 339-343.
12. 王永康. Philos 钢板联合异体腓骨治疗 Neer Ⅳ型肱骨近端骨折的疗效分析. 中国医药指南, 2017, 15(21): 128-129.
13. 朱加亮, 杨润功, 吴克俭, 等. 肱骨近端锁定钢板结合同种异体腓骨头髓腔植入治疗老年粉碎性肱骨近端骨折. 中国骨与关节杂志, 2013, 2(11): 632-636.
14. 翁蔚宗, 张军, 曹烈虎, 等. 采用同种异体腓骨植骨重建肱骨近端内侧柱的临床应用及疗效. 现代生物医学进展, 2017, 17(5): 844-848.
15. 朱正国, 齐红哲, 常祖豪, 等. 解剖型异体腓骨髓内支撑钢板内固定术治疗老年肱骨近端粉碎性骨折疗效观察. 解放军医学院学报, 2018, 39(2): 91-94.
16. 熊家伟, 苏维敏, 梁杰, 等. 同种异体腓骨段髓内移植并钢板锁定固定治疗肱骨近端 Neer Ⅲ、Ⅳ型骨折的可行性分析. 中国医学装备, 2017, 14(7): 103-106.
17. 何继业, 张家红, 王栋梁. 锁定钢板结合腓骨植骨治疗骨质疏松性肱骨近端骨折的疗效分析. 中国临床医生杂志, 2016, 44(6): 35-37.
18. 朱炼, 王博, 赵昌平, 等. 锁定钢板结合同种异体髂骨移植与腓骨移植治疗肱骨近端粉碎性骨折的对比研究. 河北医科大学学报, 2017, 38(4): 395-398.
19. 张硕, 汪秋柯, 陈云丰, 等. 锁定钢板结合异体腓骨治疗头内翻型肱骨近端骨折. 中华肩肘外科电子杂志, 2018, 6(1): 19-24.
20. Hepp P, Lill H, Bail H, et al. Where should implants be anchored in the humeral head? Clin Orthop Relat Res, 2003, (415): 139-147.
21. Krappinger D, Bizzotto N, Riedmann S, et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury, 2011, 42(11): 1283-1288.
22. 朱正国, 常祖豪, 齐红哲, 等. 解剖型腓骨髓内支撑锁定钢板固定肱骨近端骨折的有限元分析. 解放军医学院学报, 2019, 40(1): 62-67.
23. Osterhoff G, Baumgartner D, Favre P, et al. Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone. J Shoulder Elbow Surg, 2011, 20(5): 740-746.
24. 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.
25. 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.
26. Bae JH, Oh JK, Chon CS, et al. The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. J Bone Joint Surg (Br), 2011, 93(7): 937-941.
27. Lescheid J, Zdero R, Shah S, et al. The biomechanics of locked plating for repairing proximal humerus fractures with or without medial cortical support. J Trauma, 2010, 69(5): 1235-1242.
28. Agudelo J, Schürmann M, Stahel P, et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma, 2007, 21(10): 676-681.
29. Chen H, Yin P, Wang S, et al. The augment of the stability in locking compression plate with intramedullary fibular allograft for proximal humerus fractures in elderly people. Biomed Res Int, 2018, 2018: 3130625.
30. 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.
31. Lee S, Han S, Yoo B, 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.
32. Little MT, Berkes MB, Schottel PC, et al. The impact of preoperative coronal plane deformity on proximal humerus fixation with endosteal augmentation. J Orthop Trauma, 2014, 28(6): 338-347.
33. 潘俊曦, 陈柏行, 陈浩, 等. 经皮微创内固定结合重建内侧柱治疗肱骨近端骨折疗效分析. 实用骨科杂志, 2018, 24(9): 833-836.
34. 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.
35. 常祖豪, 朱正国, 齐红哲, 等. 锁定钢板结合异体腓骨治疗老年肱骨近端粉碎性骨折的中远期疗效观察. 解放军医学院学报, 2019, 40(2): 106-112.
36. Hayes K, Walton JR, Szomor ZL, et al. Reliability of five methods for assessing shoulder range of motion. Australian J Physiother, 2001, 47(4): 289-294.
37. Hudak PL, Amadio PC, Bombardier C, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med, 1996, 29(6): 602-608.
38. Conboy VB, Morris RW, Kiss J, et al. An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg (Br), 1996, 78(2): 229-232.
39. Marchese C, Cristalli G, Pichi B, et al. Italian cross-cultural adaptation and validation of three different scales for the evaluation of shoulder pain and dysfunction after neck dissection: University of California-Los Angeles (UCLA) Shoulder Scale, Shoulder Pain and Disability Index (SPADI) and Simple Shoulder Test (SST). Acta Otorhinolaryngol Ital, 2012, 32(1): 12-17.
40. 张保焜, 刘敬文, 丁坚, 等. 异体腓骨辅助解剖复位对肱骨近端骨折预后的影响. 上海医学, 2017, 40(6): 359-362.
41. Chen H, Ji X, Zhang Q, et al. Clinical outcomes of allograft with locking compression plates for elderly four-part proximal humerus fractures. J Orthop Surg Res, 2015, 10: 114.
42. Matassi F, Angeloni R, Carulli C, et al. Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus. Injury, 2012, 43(11): 1939-1942.
43. 唐佶颖, 陶忠亮, 李军, 等. 同期和延期修复肱骨近端骨折合并的肩袖全层破裂疗效比较. 中国修复重建外科杂志, 2019, 33(9): 1141-1146.
44. 李文庆, 张作君, 刘云龙. 肱骨近端脱套样骨折治疗体会. 中国修复重建外科杂志, 2018, 32(12): 1540-1544.
45. Hertel R. Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int, 2005, 16(Suppl 2): S65-72.
46. Kannus P, Palvanen M, Niemi S, et al. Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium. Acta Orthop Scand, 2000, 71(5): 465-470.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress in treatment of proximal humeral fracture with fibular allograft and locking plate

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