Treatment of elderly comminuted proximal humeral fracture using endosteal anatomical support system: A case report

INTRODUCTION: Intramedullary anatomical medial strut with allograft bone (IAMSAB), which accommodates the shape of the proximal humeral cavity and provides rotational stability and direct support to the medial column, was successfully introduced to augment Lateral locking plate (LLP) in the treatment of elderly comminuted proximal humeral fractures. Based on the LLP-IAMSAB construct, a newly titanium endosteal anatomical support system (EASS) was developed. CASE PRESENTATION: Reported here is a single case of a highly comminuted proximal humeral fracture. The fractures were treated with EASS. The patient's fracture healed properly. The 24-month follow-up demonstrated no pain and a good functional outcome, with no signs of reduction loss, absorption of greater tuberosity, varus displacement and avascular necrosis of humeral head. CLINICAL DISCUSSION: The newly developed EASS had several special considerations contributing to satisfactory surgical outcome. The flat plane construct of the proximal end of the EASS directly support humeral head to prevent varus displacement of the humeral head, instead of the purchase between the screw thread and the cancellous bone inside the humeral head in the nail or plate fixation. Medial anatomical shape of proximal end helps to reduce medial cortex reduction. Greater tuberosity support block with rotator cuff suture fixation might promote greater tuberosity healing and prevent its absorption. However, there is no similar construct in the nail or plate fixation. CONCLUSION: The newly developed endosteal anatomical support system might be a promising option in the treatment of elderly comminuted proximal humeral fractures. Although the effectiveness of this system requires additional evaluation upon more patients being treated with this surgical method, the newly developed EASS may serve as a humeral head-preserving method for elderly patients with comminuted proximal humeral fractures.