Research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHANG Zuhao , ZHANG Wei , TANG Peifu ,  CHEN Hua

Department of Orthopedics, Chinese PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China;

Corresponding author：

CHEN Hua, Email: chenhua0270@126.com

Keywords：

Proximal humeral fracture; medial support augmentation of plate osteosynthesis; intramedullary support; extramedullary support; osteoporotic fracture

DOI：

10.7507/1002-1892.202009127

Video：

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Objective To review the literature about the clinical application and research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures, and to provide reference for clinical treatment.Methods The literature concerning medial support augmentation of plate osteosynthesis for proximal humeral fractures in recent years was extensively reviewed, as well as the biomechanical benefit and clinical advantage were analyzed thoroughly.Results Medial support augmentation of plate osteosynthesis for proximal humeral fractures is very important, especially in osteoporotic and/or comminuted fractures. Many medial support augmentation methods have been proposed which can be divided into extramedullary support and intramedullary support. It can also be divided into autogenous bone support and allogenic bone support according to the material and source, divided into medial column support, calcar support, and humeral head support according to the support site, and divided into fibular shaft support, femoral head support, anatomic fibula support according to the shape of the augmented fixation. At present, clinical and biomechanical researches show that medial support augmentation is an effective treatment for proximal humeral fractures.Conclusion As an important treatment strategy for the treatment of proximal humeral fractures, the medial support augmentation of plate osteosynthesis gets the focus from the biomechanical studies and clinical treatment. However, there are still widespread controversies among orthopedic surgeons regarding the support mode, site, implant shape, and material of medial column support for augmentation of proximal humeral fractures. More high-quality clinical trials and biomechanical researches as well as multi-disciplinary integration, are needed to provide better strategy treatment for the treatment of proximal humeral fractures.

Citation： CHANG Zuhao, ZHANG Wei, TANG Peifu, CHEN Hua. Research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(3): 375-380. doi: 10.7507/1002-1892.202009127 Copy

1.	Biermann N, Prall WC, Böcker W, et al. Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies. Arch Orthop Trauma Surg, 2019, 139(8): 1075-1099.
2.	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.
3.	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.
4.	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.
5.	Walch G, Badet R, Nové-Josserand L, et al. Nonunions of the surgical neck of the humerus: surgical treatment with an intramedullary bone peg, internal fixation, and cancellous bone grafting. J Shoulder Elbow Surg, 1996, 5(3): 161-168.
6.	Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury, 2006, 37(8): 691-697.
7.	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.
8.	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.
9.	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(1): 114.
10.	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.
11.	Parada SA, Makani A, Stadecker MJ, et al. Technique of open reduction and internal fixation of comminuted proximal humerus fractures with allograft femoral head metaphyseal reconstruction. Am J Orthop (Belle Mead NJ), 2015, 44(10): 471-475.
12.	Choi S, Kang H, Bang H. Technical tips: dualplate fixation technique for comminuted proximal humerus fractures. Injury, 2014, 45(8): 1280-1282.
13.	Theopold J, Marquaß B, Fakler J, et al. The bicipital groove as a landmark for reconstruction of complex proximal humeral fractures with hybrid double plate osteosynthesis. BMC Surg, 2016, 16: 10.
14.	Wanner GA, Wanner-Schmid E, Romero J, et al. Internal fixation of displaced proximal humeral fractures with two one-third tubular plates. J Trauma, 2003, 54(3): 536-544.
15.	He Y, Zhang Y, Wang Y, et al. Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support. J Orthop Surg Res, 2017, 12(1): 72.
16.	Theopold J, Schleifenbaum S, Müller M, et al. Biomechanical evaluation of hybrid double plate osteosynthesis using a locking plate and an inverted third tubular plate for the treatment of proximal humeral fractures. PLoS One, 2018, 13(10): e0206349.
17.	李明超, 肖睿, 张广平, 等. 自体髂骨移植结合锁定钢板内固定治疗肱骨近端粉碎性骨折的前瞻性研究. 中国骨与关节杂志, 2018, 7(7): 484-488.
18.	Gao K, Gao W, Huang J, et al. Treatment of surgical neck nonunions of the humerus with locked plate and autologous fibular strut graft. Med Princ Pract, 2012, 21(5): 483-487.
19.	Ring D, McKee MD, Perey BH, et al. The use of a blade plate and autogenous cancellous bone graft in the treatment of ununited fractures of the proximal humerus. J Shoulder Elbow Surg, 2001, 10(6): 501-507.
20.	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.
21.	王尧, 曹烈虎, 崔进, 等. 锁定钢板联合同种异体腓骨植骨与半肩关节置换治疗老年复杂肱骨近端骨折疗效的对比研究. 中华肩肘外科电子杂志, 2019, 7(2): 128-135.
22.	Cui X, Chen H, Ma B, et al. Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study. BMC Musculoskelet Disord, 2019, 20(1): 511.
23.	Wang H, Rui B, Lu S, et al. Locking plate use with or without strut support for varus displaced proximal humeral fractures in elderly patients. JBJS Open Access, 2019, 4(3): 1-8.
24.	Tepass A, Blumenstock G, Weise K, et al. Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg, 2013, 22(1): e8-e14.
25.	Ockert B, Siebenbürger G, Kettler M, et al. Long-term functional outcomes (median 10 years) after locked plating for displaced fractures of the proximal humerus. J Shoulder Elbow Surg, 2014, 23(8): 1223-1231.
26.	Jost B, Spross C, Grehn H, et al. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg, 2013, 22(4): 542-549.
27.	Haasters F, Siebenbürger G, Helfen T, et al. Complications of locked plating for proximal humeral fractures-are we getting any better? J Shoulder Elbow Surg, 2016, 25(10): e295-e303.
28.	Euler SA, Hengg C, Wambacher M, et al. Allogenic bone grafting for augmentation in two-part proximal humeral fracture fixation in a high-risk patient population. Arch Orthop Trauma Surg, 2015, 135(1): 79-87.
29.	Cha H, Park KB, Oh S, et al. Treatment of comminuted proximal humeral fractures using locking plate with strut allograft. J Shoulder Elbow Surg, 2017, 26(5): 781-785.
30.	Chen H, Zhu ZG, Li JT, et al. Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column instability: A cohort study. Int J Surg, 2020, 73: 50-56.
31.	沈施耘, 李雄峰, 吴猛, 等. 锁定钢板结合不同腓骨植骨方式治疗肱骨近端骨折的生物力学稳定性分析. 中华创伤骨科杂志, 2019, 21(5): 427-431.
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.	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.
34.	张军, 庄云强, 李东贞, 等. 锁定钢板结合异体腓骨支撑治疗老年肱骨近端 Neer 三、四部分骨折. 中华创伤骨科杂志, 2018, 20(11): 946-952.
35.	周君琳. 复杂肱骨近端骨折内固定治疗. 中华肩肘外科电子杂志, 2019, 7(1): 93.
36.	葛鸿庆, 郑沐欣, 管华. 锁定钢板联合异体腓骨支撑治疗老年内翻型肱骨近端骨折. 中华创伤骨科杂志, 2019, 21(5): 440-442.
37.	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.
38.	Davids S, Allen D, Desarno M, et al. Comparison of locked plating of varus displaced proximal humeral fractures with and without fibula allograft augmentation. J Orthop Trauma, 2020, 34(4): 186-192.
39.	Barlow JD, Logli AL, Steinmann SP, et al. Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. J Shoulder Elbow Surg, 2020, 29(8): 1689-1694.
40.	Manzi JE, Ruzbarsky JJ, Rauck RC, et al. Failed proximal humerus osteosynthesis using intramedullary fibular strut allograft conversion to reverse shoulder arthroplasty. Tech Hand Up Extrem Surg, 2020, 24(1): 7-12.

1. Biermann N, Prall WC, Böcker W, et al. Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies. Arch Orthop Trauma Surg, 2019, 139(8): 1075-1099.
2. 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.
3. 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.
4. 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.
5. Walch G, Badet R, Nové-Josserand L, et al. Nonunions of the surgical neck of the humerus: surgical treatment with an intramedullary bone peg, internal fixation, and cancellous bone grafting. J Shoulder Elbow Surg, 1996, 5(3): 161-168.
6. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury, 2006, 37(8): 691-697.
7. 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.
8. 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.
9. 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(1): 114.
10. 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.
11. Parada SA, Makani A, Stadecker MJ, et al. Technique of open reduction and internal fixation of comminuted proximal humerus fractures with allograft femoral head metaphyseal reconstruction. Am J Orthop (Belle Mead NJ), 2015, 44(10): 471-475.
12. Choi S, Kang H, Bang H. Technical tips: dualplate fixation technique for comminuted proximal humerus fractures. Injury, 2014, 45(8): 1280-1282.
13. Theopold J, Marquaß B, Fakler J, et al. The bicipital groove as a landmark for reconstruction of complex proximal humeral fractures with hybrid double plate osteosynthesis. BMC Surg, 2016, 16: 10.
14. Wanner GA, Wanner-Schmid E, Romero J, et al. Internal fixation of displaced proximal humeral fractures with two one-third tubular plates. J Trauma, 2003, 54(3): 536-544.
15. He Y, Zhang Y, Wang Y, et al. Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support. J Orthop Surg Res, 2017, 12(1): 72.
16. Theopold J, Schleifenbaum S, Müller M, et al. Biomechanical evaluation of hybrid double plate osteosynthesis using a locking plate and an inverted third tubular plate for the treatment of proximal humeral fractures. PLoS One, 2018, 13(10): e0206349.
17. 李明超, 肖睿, 张广平, 等. 自体髂骨移植结合锁定钢板内固定治疗肱骨近端粉碎性骨折的前瞻性研究. 中国骨与关节杂志, 2018, 7(7): 484-488.
18. Gao K, Gao W, Huang J, et al. Treatment of surgical neck nonunions of the humerus with locked plate and autologous fibular strut graft. Med Princ Pract, 2012, 21(5): 483-487.
19. Ring D, McKee MD, Perey BH, et al. The use of a blade plate and autogenous cancellous bone graft in the treatment of ununited fractures of the proximal humerus. J Shoulder Elbow Surg, 2001, 10(6): 501-507.
20. 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.
21. 王尧, 曹烈虎, 崔进, 等. 锁定钢板联合同种异体腓骨植骨与半肩关节置换治疗老年复杂肱骨近端骨折疗效的对比研究. 中华肩肘外科电子杂志, 2019, 7(2): 128-135.
22. Cui X, Chen H, Ma B, et al. Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study. BMC Musculoskelet Disord, 2019, 20(1): 511.
23. Wang H, Rui B, Lu S, et al. Locking plate use with or without strut support for varus displaced proximal humeral fractures in elderly patients. JBJS Open Access, 2019, 4(3): 1-8.
24. Tepass A, Blumenstock G, Weise K, et al. Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg, 2013, 22(1): e8-e14.
25. Ockert B, Siebenbürger G, Kettler M, et al. Long-term functional outcomes (median 10 years) after locked plating for displaced fractures of the proximal humerus. J Shoulder Elbow Surg, 2014, 23(8): 1223-1231.
26. Jost B, Spross C, Grehn H, et al. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg, 2013, 22(4): 542-549.
27. Haasters F, Siebenbürger G, Helfen T, et al. Complications of locked plating for proximal humeral fractures-are we getting any better? J Shoulder Elbow Surg, 2016, 25(10): e295-e303.
28. Euler SA, Hengg C, Wambacher M, et al. Allogenic bone grafting for augmentation in two-part proximal humeral fracture fixation in a high-risk patient population. Arch Orthop Trauma Surg, 2015, 135(1): 79-87.
29. Cha H, Park KB, Oh S, et al. Treatment of comminuted proximal humeral fractures using locking plate with strut allograft. J Shoulder Elbow Surg, 2017, 26(5): 781-785.
30. Chen H, Zhu ZG, Li JT, et al. Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column instability: A cohort study. Int J Surg, 2020, 73: 50-56.
31. 沈施耘, 李雄峰, 吴猛, 等. 锁定钢板结合不同腓骨植骨方式治疗肱骨近端骨折的生物力学稳定性分析. 中华创伤骨科杂志, 2019, 21(5): 427-431.
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. 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.
34. 张军, 庄云强, 李东贞, 等. 锁定钢板结合异体腓骨支撑治疗老年肱骨近端 Neer 三、四部分骨折. 中华创伤骨科杂志, 2018, 20(11): 946-952.
35. 周君琳. 复杂肱骨近端骨折内固定治疗. 中华肩肘外科电子杂志, 2019, 7(1): 93.
36. 葛鸿庆, 郑沐欣, 管华. 锁定钢板联合异体腓骨支撑治疗老年内翻型肱骨近端骨折. 中华创伤骨科杂志, 2019, 21(5): 440-442.
37. 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.
38. Davids S, Allen D, Desarno M, et al. Comparison of locked plating of varus displaced proximal humeral fractures with and without fibula allograft augmentation. J Orthop Trauma, 2020, 34(4): 186-192.
39. Barlow JD, Logli AL, Steinmann SP, et al. Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. J Shoulder Elbow Surg, 2020, 29(8): 1689-1694.
40. Manzi JE, Ruzbarsky JJ, Rauck RC, et al. Failed proximal humerus osteosynthesis using intramedullary fibular strut allograft conversion to reverse shoulder arthroplasty. Tech Hand Up Extrem Surg, 2020, 24(1): 7-12.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress on medial support augmentation of plate osteosynthesis for proximal humeral fractures

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