| Purpose: Locking plate constructs for proximal humeral fractures can fail due to varus collapse,especially in osteoporotic bone with medial cortex comminution.This study investigated the ability of the locking plate construct with fibular autograft to withstand varus stresses while changing the way of augmentation.Materials and methods: Proximal humeral fractures with medial comminution were simulated by performing wedge-shaped osteotomies at the surgical neck in cadaveric specimens.For each cadaver(n =6,with 12 humerus),one humeral fracture was fixated with the locking plate construct with vertically fibular autograft augmentation as group A and the other side with slantly fibular autograft augmentation as group B.The humerus was immobilized and a repetitive varus stress was applied to the proximal humerus until construct collapse.Results: Collapse in group A occurred after an average of 31338±5994 cycles,the number in group B is 30608±8015.The numbers of cycles when test stopped in group A compared to group B is no statistically significant(P<0.05).Conclusion: Locking plate construct with slantly fibular autograft augmentation provided no more strength to withstand repetitive varus stresses relative to the vertically fibular autograft augmentation.Clinically,locking plate with vertically fibular allograft is an effective treatment for complex proximal humeral fracture in osteoporotic bone with medial cortex comminution. |
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