Hospital for Special Surgery, New York, NY 10021, USA.
J Orthop Trauma. 2012 Apr;26(4):212-5. doi: 10.1097/BOT.0b013e318243909c.
To report on the use of a supplemental medial endosteal implant to prevent varus collapse and screw cutout in proximal humerus fractures treated with a laterally placed locking plate.
Twenty-seven patients meeting study inclusion criteria were included in the study. Follow-up averaged 63.1 weeks (minimum 37 weeks and maximum 120 weeks). All patients were either older than 70 years or had sustained a proximal humerus fracture with medial comminution. Using the anterolateral acromial approach, a proximal humeral locking plate augmented with a medial endosteal implant (fibular allograft in 23 patients and semitubular plate in 4 patients) was used for fixation. Intraoperative fluoroscopic images and the most recent follow-up radiographs were used to measure the head-shaft angle and loss of height between the implant and the articular surface.
Only 1 of 27 patients had significant loss of reduction with collapse of the fracture into varus (4.2 mm change). Ninety-six percent of patients maintained their original reduction with an average loss of height of 1.2 mm and an average change in shaft-head angle of 2.2 degrees. There were no implant failures or screw perforations of the articular surface and no radiographic or clinical evidence of AVN.
Use of a medial endosteal implant as a supplement to a lateral locking plate is effective in maintaining operative reduction, preventing varus collapse, and implant failure in fractures with medial comminution and/or poor bone quality.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
报告使用附加的内侧皮质骨内植入物预防外侧放置锁定钢板治疗肱骨近端骨折时发生的内翻塌陷和螺钉切出。
本研究纳入了符合研究纳入标准的 27 名患者。平均随访时间为 63.1 周（最短 37 周，最长 120 周）。所有患者均为 70 岁以上或存在内侧粉碎性肱骨近端骨折。采用前外侧肩峰入路，使用带有内侧皮质骨内植入物（23 例患者使用腓骨同种异体移植物，4 例患者使用半管状钢板）的肱骨近端锁定钢板进行固定。术中透视图像和最近的随访 X 线片用于测量头干角和植入物与关节面之间的高度丢失。
仅 1 例患者（4.2 毫米的改变）发生明显的复位丢失和骨折内翻塌陷。96%的患者保持了原始复位，平均高度丢失 1.2 毫米，骨干头角度平均变化 2.2 度。无植入物失败或关节面螺钉穿透，无 AVN 的放射学或临床证据。
在存在内侧粉碎和/或骨质量差的骨折中，使用内侧皮质骨内植入物作为外侧锁定钢板的补充物可有效维持手术复位、防止内翻塌陷和植入物失败。
治疗性 IV 级。有关证据水平的完整描述，请参见作者指南。
