title: Outcomes for four-part proximal humerus fractures treated with a locking compression plate and an autologous iliac bone impaction graft.
abstract: OBJECTIVE
  The study aims to evaluate outcomes of autologous iliac bone impaction grafts (AIBIGs) with locking-compression plates (LCPs) in four-part proximal humeral fracture.
  
  
  METHODS
  Between October 2004 and October 2008, 21 AIBIG with LCP osteosyntheses were done for four-part proximal humeral fractures. Patients included seven males and 14 females. Their mean age at the time of the operation was 66.3±16.9 years (range: 24-87 years). Five patients had high-energy fractures other than fall from standing height. There were two fracture-dislocation cases, and three valgus-impacted fractures. The length of the calcar segment attached to the articular segment was 7.04±6.10mm; 13 of the 21 cases had lengths less than 8mm. Medial-hinge displacement was 16.77±15.84mm; 19 of the 21 cases had displacements more than 2mm.
  
  
  RESULTS
  There was no avascular necrosis of the humeral head and union was achieved in all cases. Varus collapse and hardware-related complications were not observed. Postoperative neck-shaft angles were found to be 129±9° (range: 109-146°). Neer scores were 92.0±6.3 (range: 81-100).
  
  
  CONCLUSIONS
  The results of using AIBIG with LCP for four-part proximal humeral fractures are excellent. There are significant bone defects in osteoporotic or comminuted fractures and LCP alone does not always provide reliable fixation. Therefore, meticulous technique and use of AIBIG in this complicated type of fracture can ensure a favourable outcome.
authors: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea. drjacobkim@gmail.com
authors: Sae Hoon
authors: SH
authors: Kim
authors: Young Ho
authors: YH
authors: Lee
authors: Seok Won
authors: SW
authors: Chung
authors: Seung Han
authors: SH
authors: Shin
authors: Woo Young
authors: WY
authors: Jang
authors: Hyun Sik
authors: HS
authors: Gong
authors: Goo Hyun
authors: GH
authors: Baek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007085:Ilium / Q000601:surgery / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000517:prevention & control; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult