title: Allograft augmentation in proximal humerus fractures.
abstract: OBJECTIVE
  Achieve stable fixation to initially start full range of motion (ROM) and to prevent secondary displacement in unstable fracture patterns and/or weak and osteoporotic bone.
  
  
  METHODS
  (Secondarily) displaced proximal humerus fractures (PHF) with an unstable medial hinge and substantial bony deficiency, weak/osteoporotic bone, pre-existing psychiatric illnesses or patient incompliance to obey instructions.
  
  
  METHODS
  Open/contaminated fractures, systemic immunodeficiency, prior graft-versus-host reaction.
  
  
  METHODS
  Deltopectoral approach. Identification of the rotator cuff. Disimpaction and reduction of the fracture, preparation of the situs. Graft preparation. Allografting. Fracture closure. Plate attachment. Definitive plate fixation. Radiological documentation. Postoperative shoulder fixation (sling).
  
  
  METHODS
  Cryotherapy, anti-inflammatory medication on demand. Shoulder sling for comfort. Full active physical therapy as tolerated without pain. Postoperative radiographs (anteroposterior, outlet, and axial [as tolerated] views) and clinical follow-up after 6 weeks and 3, 6, and 12 months.
  
  
  RESULTS
  Bony union and allograft incorporation in 9 of 10 noncompliant, high-risk patients (median age 63 years) after a mean follow-up of 28.5 months. The median Constant-Murley Score was 72.0 (range 45-86). Compared to the uninjured contralateral side, flexion was impaired by 13 %, abduction by 14 %, and external rotation by 15 %. Mean correction of the initial varus displacement was 38° (51° preoperatively to 13° postoperatively).
authors.affiliation: Klinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. simon.euler@tirol-kliniken.at.
authors.forename: S A
authors.initials: SA
authors.lastname: Euler
authors.affiliation: Unfallchirurgische Abteilung, Wilhelminenspital Wien, Montlearstr. 37, Vienna, 1160, Austria.
authors.forename: F S
authors.initials: FS
authors.lastname: Kralinger
authors.affiliation: Klinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Hengg
authors.affiliation: Klinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Wambacher
authors.affiliation: Klinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Blauth
mesh_terms: D000368:Aged; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012784:Shoulder Fractures / Q000175:diagnosis* / Q000601:surgery*; D014184:Transplantation, Homologous / Q000379:methods / Q000534:rehabilitation; D016896:Treatment Outcome
keywords: Allograft; Displacement; Patient non-compliance; Plate fixation; Proximal humerus fracture