title: Treatment of comminuted proximal humeral fractures using locking plate with strut allograft.
abstract: BACKGROUND
  This study compared the radiologic outcome of fixation using locking plate only with fixation using locking plate with an endosteal strut allograft in the treatment of comminuted proximal humeral fracture.
  
  
  METHODS
  Among 52 patients with comminuted proximal humeral fracture, 32 patients underwent fixation with locking plate only, and 20 patients underwent fixation using locking plate with an endosteal strut allograft. The strut allograft was inserted into the intramedullary cavity of the humerus to support the humeral head and fixed with the locking plate. Immediate postoperative radiologic findings were compared with those of 6 months or more after the surgery, and loss of anatomic fixation was defined if the varus malalignment of neck-shaft angle (NSA) was more than 5° or if the change of humeral head height (HHH) was more than 3 mm.
  
  
  RESULTS
  In the locking plate-only group, 22 of 32 patients (69%) showed the change in NSA of more than 5°, with an average of 10.2°. The HHH change in 20 patients (62.5%) was more than 3 mm, with an average of 4 mm. Among 20 patients who underwent locking plate with the endosteal strut allograft, the average NSA and HHH change was 3° and 1 mm, respectively. Varus malalignment was evident in 2 patients (10%). The HHH change was more than 3 mm in 1 patient (5%).
  
  
  CONCLUSIONS
  Fixation using a locking plate with an endosteal strut allograft can be considered a reasonable option to maintain the anatomic reduction in elderly patients with comminuted proximal humeral fracture.
authors.affiliation: Department of Orthopedic Surgery, Mirae Hospital, Busan, Republic of Korea.
authors.forename: Hongeun
authors.initials: H
authors.lastname: Cha
authors.affiliation: Department of Orthopedic Surgery, Seran General Hospital, Seoul, Republic of Korea.
authors.forename: Ki-Beom
authors.initials: KB
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Seungbae
authors.initials: S
authors.lastname: Oh
authors.affiliation: Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: osjeong@hotmail.com.
authors.forename: Jinyoung
authors.initials: J
authors.lastname: Jeong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D016025:Bone Transplantation; D005260:Female; D005593:Fracture Fixation, Internal; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Proximal humerus; allograft; comminuted fracture; humeral head height; locking plate; neck-shaft angle