proximal humeral fractures treated with locked plating and an intramedullary strut allograft: a...
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PROXIMAL HUMERAL FRACTURES TREATED WITH LOCKED PLATING AND AN INTRAMEDULLARY STRUT
ALLOGRAFT:A RETROSPECTIVE ANALYSIS
BRIAN L. BADMAN MD
JONATHAN LEVY MD
RANDALL OTTO MD
MARK MIGHELL MD
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DISCLOSURES:
• BRIAN BADMAN MD
• PAID CONSULTANT, ROYALTIES, INVESTOR UPEX
• PAID CONSULTANT DJO SURGICAL
• JONATHAN LEVY MD
• PAID CONSULTANT DJO SURGICAL, ARTHREX, STRYKER ORTHOPAEDICS
• RANDALL OTTO MD
• HONORARIUM DJO SURGICAL
• MARK MIGHELL MD
• PAID CONSULTANT, ROYALTIES, INVESTOR UPEX
• PAID CONSULTANT DJO SURGICAL
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BACKGROUND
• LOCKED PLATING: TREATMENT OPTION FOR PROXIMAL HUMERAL FRACTURES
• IMPLANT COMPLICATIONS : SCREW CUTOUT AND VARUS RELATIVELY COMMON
• ENDOSTEAL ALLOGRAFT STRUT FOR REDUCTION AND MEDIAL CALCAR RESTORATION
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BACKGROUND
• 27 PATIENTS
• 23 FIBULA AND 4 SEMITUBULAR PLATES
• 96% PATIENTS MAINTAINED REDUCTION
• CONCLUSION:
• ENDOSTEAL IMPLANT WITH LOCKING PLATE CAN AVOID VARUS COLLAPSE
Locked Plating of the Proximal Humerus Using an Endosteal Implant
Hettrich, Neviaser, Beamer et al; 2012; 26(4); 212-215
Proximal Humeral Fracture Fixation: Locking Plate Constuct +/- Intramedullary fibular allograft
Chow, Begum, Beaupre, Carey2012 Jul;21(7):894-901
• 16 CADAVER HUMERII
• 8 LOCKING PLATE + FIBULA, 6 COLLAPSED
• 8 LOCKING PLATE ONLY, 0 COLLAPSED
• LOADED TO FAILURE OR 25,OOO CYCLES
• CONCLUSION:
• PLATE + FIBULA BETTER WITHSTANDS VARUS LOADING
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HYPOTHESIS:
• LOCKED LATERAL PLATING COMBINED WITH AN INTRAMEDULLARY ALLOGRAFT FOR THE TREATMENT OF PROXIMAL HUMERUS FRACTURES WOULD BE SIMILAR TO PUBLISHED STUDIES AND MITIGATE VARUS COLLAPSE
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METHODS
• RETROSPECTIVE ANALYSIS OF ALL 2-,3- AND 4-PART FRACTURES TREATED WITH LOCKED PLATING AND INTRAMEDULLARY ALLOGRAFT• 2PART—19(30%)• 3PART—33(50%)• 4PART—13(20%)
• MINIMUM ONE YEAR CLINICAL F/U
• 65 PATIENTS
• AVG AGE 68YRS
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METHODS
• XRAYS REVIEWED BY INDEPENDENT OBSERVER
• ASSOCIATIONS BETWEEN PATIENT AND FRACTURE SPECIFIC FACTORS
• AGE (>65 OR < 65YRS)
• FRACTURE TYPE (2, 3, OR 4-PART)
• HERTEL CRITERIA (>8MM OR <8MM MEDIAL HINGE)
• GENDER
• ASES SCORE
• SHOULDER ROM USING GONIOMETER.
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RESULTS
• AVG F/U 22 MONTHS (RANGE: 12-53)
• AVERAGE ASES SCORE: 79 (RANGE: 15-100)
• AVERAGE ROM
• FF: 125° (RANGE: 40°-180°)
• EXTERNAL ROTATION: 39° (RANGE: 0°-90°)
• HERTEL CRITERIA—MEDIAL HINGE
• 46 (71%) <8MM
• 19 (29%) >8MM
• MEAN HUMERAL NECK SHAFT ANGLE: 127° (RANGE, 104°-145°)
• 100% UNION• AVG TIME: 4.2M (RANGE: 1.5-8M)
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RESULTS
• OVERALL COMPLICATION RATE: 18% (12/65)
• FRACTURE MALUNION: 15% (10/65)
◦ 2 GREATER TUBEROSITY AVULSIONS
◦ 8 VARUS MALUNIONS (12%)
- 2 PATIENTS WITH VARUS MALUNIONS ALSO HAD SCREW PENETRATION
• SCREW PENETRATION: 6% (4/65)
• AVASCULAR NECROSIS: 3% (2/65)
• NO STATISTICAL DIFFERENCE IN FUNCTIONAL OUTCOME, COMPLICATION RATE OR INCIDENCE AVN BASED ON AGE, GENDER, OR FRACTURE TYPE.
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CONCLUSION• ALLOGRAFT STRUT HELPFUL AS REDUCTION AID AND INITIAL STABILITY IN
SITUATIONS OF METAPHYSEAL AND MEDIAL CALCAR COMMINUTION
• VARUS COLLAPSE WAS NOT DIMINISHED BY USE OF AN ALLOGRAFT STRUT
• UTILITY OF THIS TECHNIQUE IN “SOLVING” THIS PROBLEM IS QUESTIONED
• REVISION SURGERY HARDER
• AVOIDANCE OF THIS COMPLICATION IS LIKELY MULTIFACTORIAL RELATED TO TECHNICAL FACTORS (MEDIAL SUPPORT, CALCAR SCREWS, ETC) AND PATIENT FACTORS (OSTEOPOROSIS, PATIENT COMPLIANCE, ETC)
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THANK YOU