First Orthopedic Clinic, Department of Special Surgical Science, University of Florence, CTO-Largo Palagi 1, 50139 Florence, Italy.
Injury. 2012 Nov;43(11):1939-42. doi: 10.1016/j.injury.2012.08.004. Epub 2012 Aug 22.
The use of an intramedullary fibular allograft together with a locking plate fixation has been recently described in biomechanical studies to provide additional medial support and prevent varus malalignment for displaced proximal humeral fractures with promising results. The aim of this study was to evaluate the clinical and radiographic outcome of a locking plate with fibular allograft augmentation in unstable humeral fractures.
We prospectively assessed the functional outcome and complications in 17 patients with proximal humeral fractures with disrupted medial column, treated with a locking plate and a fibular strut graft. The median patient age was 62 years. Postoperative assessments included radiographic imaging, range of motion, pain according to the visual analogue scale (VAS), Short Form (SF36) Health Survey, Constant-Murley and Disabilities of the Arm, Shoulder and Hand (DASH) shoulder scores as well as return to previous occupation and complications.
No patients were lost to follow-up and no major complications were recorded. There was no collapse of the humeral head more than 2mm, osteonecrosis or screw penetration of the articular surface. All fractures healed clinically and radiographically. After an average follow-up of 13 months, the mean Constant score was 79 points. The mean active flexion was 149°; extension, 47°; internal rotation, 40°; external rotation, 65°; and abduction, 135°. The median VAS pain level was 1 point. The median DASH score was 33 points, and the median SF36 was 83 points.
Locking plate with fibular graft augmentation is a safe and promising technique to support the humeral head and maintain reduction in the proximal humeral fracture with medial comminution.
在生物力学研究中，最近有研究描述了使用髓内腓骨同种异体移植并结合锁定钢板固定，以提供额外的内侧支撑并防止移位的肱骨近端骨折发生内翻畸形，结果令人鼓舞。本研究旨在评估锁定钢板联合腓骨同种异体骨移植增强在不稳定肱骨骨折中的临床和影像学结果。
我们前瞻性评估了 17 例伴有内侧柱中断的肱骨近端骨折患者采用锁定钢板和腓骨支撑移植物治疗的功能结果和并发症。患者的中位年龄为 62 岁。术后评估包括影像学检查、活动范围、视觉模拟评分（VAS）疼痛、SF-36 健康调查、Constant-Murley 和肩手残疾（DASH）评分以及重返先前职业和并发症。
无患者失访，无重大并发症记录。无肱骨头塌陷超过 2mm、骨坏死或关节面螺钉穿透。所有骨折均临床和影像学愈合。平均随访 13 个月后，平均 Constant 评分为 79 分。平均主动屈曲为 149°；伸展为 47°；内旋为 40°；外旋为 65°；外展为 135°。VAS 疼痛中位数为 1 分。DASH 中位数为 33 分，SF-36 中位数为 83 分。
锁定钢板联合腓骨移植增强是一种安全且有前途的技术，可用于支撑肱骨头并维持内侧粉碎性肱骨近端骨折的复位。
