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Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes
BACKGROUND: Early failure of osteosyntheses is common even with use of locking plates. In patients with comminuted fractures and epiphyseal osseous defects, we performed a series of osteosyntheses by locking plate in combination with an allograft bone augmentation. Because of encouraging short-term...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142705/ https://www.ncbi.nlm.nih.gov/pubmed/34006820 http://dx.doi.org/10.12659/MSM.928982 |
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author | Polykandriotis, Elias Zschiegner, Annelie Horch, Raymund E. Schürmann, Matthias |
author_facet | Polykandriotis, Elias Zschiegner, Annelie Horch, Raymund E. Schürmann, Matthias |
author_sort | Polykandriotis, Elias |
collection | PubMed |
description | BACKGROUND: Early failure of osteosyntheses is common even with use of locking plates. In patients with comminuted fractures and epiphyseal osseous defects, we performed a series of osteosyntheses by locking plate in combination with an allograft bone augmentation. Because of encouraging short-term results in the literature, we assumed that the method could be a potential alternative to a reverse shoulder prosthesis. MATERIAL/METHODS: Twenty-six patients with a dislocated proximal humeral fracture (Neer IV/V/VI) were studied. A lyophilized allogeneic bone graft was used to reinforce the humeral head fragments before locking plate osteosynthesis. The outcomes of fractures were assessed with Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley (Constant) scores, range of motion, a visual analog scale, and with radiological testing. The Constant-Murley scores were the endpoint of our study. RESULTS: The Neer classification of the fractures was type IV in 4 patients, type V in 20 patients, and type VI in 2 patients. The mean DASH score was 52.85 (range, 4.17–79.3) and the mean Constant score was 39.26 (range, 17–88). We observed late necrosis of the humeral head in 15 of 24 patients (62.5%), although early radiological follow-up showed that the humeral head had been anatomically reconstructed. CONCLUSIONS: Long-term follow-up demonstrated inferior functional results, as displayed by poor Constant scores. There was a high incidence of necrosis, in spite of initial anatomical reconstruction. Biointegration of the allogeneic bone graft and revascularization of the humeral head fragments could be impaired in geriatric patients who have gross dislocation. Therefore, augmentation of the humeral head with allogeneic bone grafts cannot be recommended in these patients. |
format | Online Article Text |
id | pubmed-8142705 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-81427052021-05-25 Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes Polykandriotis, Elias Zschiegner, Annelie Horch, Raymund E. Schürmann, Matthias Med Sci Monit Clinical Research BACKGROUND: Early failure of osteosyntheses is common even with use of locking plates. In patients with comminuted fractures and epiphyseal osseous defects, we performed a series of osteosyntheses by locking plate in combination with an allograft bone augmentation. Because of encouraging short-term results in the literature, we assumed that the method could be a potential alternative to a reverse shoulder prosthesis. MATERIAL/METHODS: Twenty-six patients with a dislocated proximal humeral fracture (Neer IV/V/VI) were studied. A lyophilized allogeneic bone graft was used to reinforce the humeral head fragments before locking plate osteosynthesis. The outcomes of fractures were assessed with Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley (Constant) scores, range of motion, a visual analog scale, and with radiological testing. The Constant-Murley scores were the endpoint of our study. RESULTS: The Neer classification of the fractures was type IV in 4 patients, type V in 20 patients, and type VI in 2 patients. The mean DASH score was 52.85 (range, 4.17–79.3) and the mean Constant score was 39.26 (range, 17–88). We observed late necrosis of the humeral head in 15 of 24 patients (62.5%), although early radiological follow-up showed that the humeral head had been anatomically reconstructed. CONCLUSIONS: Long-term follow-up demonstrated inferior functional results, as displayed by poor Constant scores. There was a high incidence of necrosis, in spite of initial anatomical reconstruction. Biointegration of the allogeneic bone graft and revascularization of the humeral head fragments could be impaired in geriatric patients who have gross dislocation. Therefore, augmentation of the humeral head with allogeneic bone grafts cannot be recommended in these patients. International Scientific Literature, Inc. 2021-05-19 /pmc/articles/PMC8142705/ /pubmed/34006820 http://dx.doi.org/10.12659/MSM.928982 Text en © Med Sci Monit, 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Clinical Research Polykandriotis, Elias Zschiegner, Annelie Horch, Raymund E. Schürmann, Matthias Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes |
title | Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes |
title_full | Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes |
title_fullStr | Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes |
title_full_unstemmed | Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes |
title_short | Bone Allograft and Locking Plate for Severe Proximal Humeral Fractures: Early and Late Outcomes |
title_sort | bone allograft and locking plate for severe proximal humeral fractures: early and late outcomes |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142705/ https://www.ncbi.nlm.nih.gov/pubmed/34006820 http://dx.doi.org/10.12659/MSM.928982 |
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