ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025
Clinico-radiological outcomes of four-part proximal humerus fracture fixation with fibular strut graft augmentation.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionTo study the radiological and functional outcomes of complex four-part proximal humerus fractures treated with open reduction and plate fixation with fibular strut graft augmentation. MATERIALS AND
methodsWe retrospectively analyzed 15 patients with unstable four-part proximal humerus fractures between 2021 and 2023, with a mean follow-up of 1 year. All patients underwent open reduction and plate fixation with a fibular strut graft augmentation. Radiological outcomes were the neck shaft angle (NSA), greater tuberosity (GT) to the articular surface (AS) distance, and the medial hinge reduction. Functional outcomes included the American Shoulder and Elbow Surgeons (ASES) score, DASH, and Constant-Murley (CM) score.
resultsThe mean age was 49.6 years (39-60), and all fractures were united by 14 weeks (12-18). The mean NSA was 137.33° (125-149) and the mean GT-AS distance was 5.6 mm (-2 to 8.8) at one year. The mean ASES, DASH, and CM scores at one year were 87.6, 7.05, and 75.2, respectively. The two patients with initial NSA < 130° and GT higher than the AS had poor functional outcomes and one patient had a screw back out; however, there was no loss in the reduction in all patients.
conclusionUsing a locking plate combined with a fibula autograft seems to provide a more stable structure without affecting the viability of the head's articular surface by increasing medial hinge support in unstable four-part proximal humerus fractures. Consequently, this may lead to improved clinical outcomes and reduced complication rates but is no substitute for adequate reduction.
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