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, W?hnert 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, 黃強, 張玉富. 解剖鎖定鋼板結合異體腓骨髓腔內結構植骨治療復雜肱骨近端骨折. 中華肩肘外科電子雜志, 2017, 5(4): 272-277.
11.	陳孝均, 王亮, 牟曉慶, 等. 鎖定鋼板固定聯合異體腓骨髓內移植治療老年肱骨近端Ⅲ、Ⅳ部分骨折的臨床療效分析. 創傷外科雜志, 2014, 16(4): 339-343.
12.	王永康. Philos 鋼板聯合異體腓骨治療 Neer Ⅳ型肱骨近端骨折的療效分析. 中國醫藥指南, 2017, 15(21): 128-129.
13.	朱加亮, 楊潤功, 吳克儉, 等. 肱骨近端鎖定鋼板結合同種異體腓骨頭髓腔植入治療老年粉碎性肱骨近端骨折. 中國骨與關節雜志, 2013, 2(11): 632-636.
14.	翁蔚宗, 張軍, 曹烈虎, 等. 采用同種異體腓骨植骨重建肱骨近端內側柱的臨床應用及療效. 現代生物醫學進展, 2017, 17(5): 844-848.
15.	朱正國, 齊紅哲, 常祖豪, 等. 解剖型異體腓骨髓內支撐鋼板內固定術治療老年肱骨近端粉碎性骨折療效觀察. 解放軍醫學院學報, 2018, 39(2): 91-94.
16.	熊家偉, 蘇維敏, 梁杰, 等. 同種異體腓骨段髓內移植并鋼板鎖定固定治療肱骨近端 Neer Ⅲ、Ⅳ型骨折的可行性分析. 中國醫學裝備, 2017, 14(7): 103-106.
17.	何繼業, 張家紅, 王棟梁. 鎖定鋼板結合腓骨植骨治療骨質疏松性肱骨近端骨折的療效分析. 中國臨床醫生雜志, 2016, 44(6): 35-37.
18.	朱煉, 王博, 趙昌平, 等. 鎖定鋼板結合同種異體髂骨移植與腓骨移植治療肱骨近端粉碎性骨折的對比研究. 河北醫科大學學報, 2017, 38(4): 395-398.
19.	張碩, 汪秋柯, 陳云豐, 等. 鎖定鋼板結合異體腓骨治療頭內翻型肱骨近端骨折. 中華肩肘外科電子雜志, 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.	朱正國, 常祖豪, 齊紅哲, 等. 解剖型腓骨髓內支撐鎖定鋼板固定肱骨近端骨折的有限元分析. 解放軍醫學院學報, 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, 陳柏行, 陳浩, 等. 經皮微創內固定結合重建內側柱治療肱骨近端骨折療效分析. 實用骨科雜志, 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, 朱正國, 齊紅哲, 等. 鎖定鋼板結合異體腓骨治療老年肱骨近端粉碎性骨折的中遠期療效觀察. 解放軍醫學院學報, 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.	張保焜, 劉敬文, 丁堅, 等. 異體腓骨輔助解剖復位對肱骨近端骨折預后的影響. 上海醫學, 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.	唐佶穎, 陶忠亮, 李軍, 等. 同期和延期修復肱骨近端骨折合并的肩袖全層破裂療效比較. 中國修復重建外科雜志, 2019, 33(9): 1141-1146.
44.	李文慶, 張作君, 劉云龍. 肱骨近端脫套樣骨折治療體會. 中國修復重建外科雜志, 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, W?hnert 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, 黃強, 張玉富. 解剖鎖定鋼板結合異體腓骨髓腔內結構植骨治療復雜肱骨近端骨折. 中華肩肘外科電子雜志, 2017, 5(4): 272-277.
11. 陳孝均, 王亮, 牟曉慶, 等. 鎖定鋼板固定聯合異體腓骨髓內移植治療老年肱骨近端Ⅲ、Ⅳ部分骨折的臨床療效分析. 創傷外科雜志, 2014, 16(4): 339-343.
12. 王永康. Philos 鋼板聯合異體腓骨治療 Neer Ⅳ型肱骨近端骨折的療效分析. 中國醫藥指南, 2017, 15(21): 128-129.
13. 朱加亮, 楊潤功, 吳克儉, 等. 肱骨近端鎖定鋼板結合同種異體腓骨頭髓腔植入治療老年粉碎性肱骨近端骨折. 中國骨與關節雜志, 2013, 2(11): 632-636.
14. 翁蔚宗, 張軍, 曹烈虎, 等. 采用同種異體腓骨植骨重建肱骨近端內側柱的臨床應用及療效. 現代生物醫學進展, 2017, 17(5): 844-848.
15. 朱正國, 齊紅哲, 常祖豪, 等. 解剖型異體腓骨髓內支撐鋼板內固定術治療老年肱骨近端粉碎性骨折療效觀察. 解放軍醫學院學報, 2018, 39(2): 91-94.
16. 熊家偉, 蘇維敏, 梁杰, 等. 同種異體腓骨段髓內移植并鋼板鎖定固定治療肱骨近端 Neer Ⅲ、Ⅳ型骨折的可行性分析. 中國醫學裝備, 2017, 14(7): 103-106.
17. 何繼業, 張家紅, 王棟梁. 鎖定鋼板結合腓骨植骨治療骨質疏松性肱骨近端骨折的療效分析. 中國臨床醫生雜志, 2016, 44(6): 35-37.
18. 朱煉, 王博, 趙昌平, 等. 鎖定鋼板結合同種異體髂骨移植與腓骨移植治療肱骨近端粉碎性骨折的對比研究. 河北醫科大學學報, 2017, 38(4): 395-398.
19. 張碩, 汪秋柯, 陳云豐, 等. 鎖定鋼板結合異體腓骨治療頭內翻型肱骨近端骨折. 中華肩肘外科電子雜志, 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. 朱正國, 常祖豪, 齊紅哲, 等. 解剖型腓骨髓內支撐鎖定鋼板固定肱骨近端骨折的有限元分析. 解放軍醫學院學報, 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, 陳柏行, 陳浩, 等. 經皮微創內固定結合重建內側柱治療肱骨近端骨折療效分析. 實用骨科雜志, 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, 朱正國, 齊紅哲, 等. 鎖定鋼板結合異體腓骨治療老年肱骨近端粉碎性骨折的中遠期療效觀察. 解放軍醫學院學報, 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. 張保焜, 劉敬文, 丁堅, 等. 異體腓骨輔助解剖復位對肱骨近端骨折預后的影響. 上海醫學, 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. 唐佶穎, 陶忠亮, 李軍, 等. 同期和延期修復肱骨近端骨折合并的肩袖全層破裂療效比較. 中國修復重建外科雜志, 2019, 33(9): 1141-1146.
44. 李文慶, 張作君, 劉云龍. 肱骨近端脫套樣骨折治療體會. 中國修復重建外科雜志, 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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