PHILOS With Fibular Strut Allograft Augmentation For Medial Column Communited Proximal Humerus Fractures

Purpose:Locking plate fixation is the most commonly used surgical method for proximal humerus farcture currently,but the postoperative complication rate is high.The purpose of our study was to evaluate the clinical and radiographic outcomes of patients with proximal humeral fractures which have medial column comminution treated by locking plate with endosteal fibular allograft augmentation.Methods: We retrospectively assessed the clinical and radiographic outcome of 55 patients with proximal humeral fractures with comminuted medial column,treated by locking plate along with fibular strut allograft between June 2014 and March 2016.In final analysis there were 48 patients,12 men and 36 women,average 64.3 years of age,33 to 87 years.By the Neer classification,there were 7 cases of two-part fracture,21 cases of three-part fracture and 20 cases of four part fracture.Postoperative assessments included Constant-Murley scores?Quick Disabilities of the Arm?Shoulder and Hand shoulder scores(Quick DASH),as well as Short Form(SF12)Health Survey,humeral head height loss?change in humeral neck shaft angle?postoperative complications and revision rate.Results: After an average follow-up of 16.7(12?30)months,the mean Constant score was 83.3(67?98)points?mean DASH score was 18.9(6.6?49.9)points?mean SF12 was 82.8(56?98)points.The mean change in humeral head height was1.2 mm(0.1?3.4).The mean change in neck-shaft angle was 3.1°(0.1°?9.1°)degrees.One patient have loss of reduction(2.1%),four patients have screw perforation of the articular surface(8.3%).Two of these four patients have revision surgery.Total complication rate was 10.4 %,revision rate was 4.2%.Conclusion: Locking plate alongwith endosteal fibular strut allograft augmentation is a good choice for the treatment of PHF which have medial column comminutions with low rate of complication and satisfactory functional outcomes.Fibular strut allograft may render benefits of enhancing mechanical stability of the humeral head,maintaining fracture reduction,reducing humeral head height loss and complications to ensure good clinical outcomes..