Surgical treatment of proximal humerus fractures with using the original allogeneic fibula graft: retrospective cohort study
- Authors: Vaza A.Y.1, Fain A.M.1, Skuratovskaya K.I.1, Titov R.S.1, Borovkova N.V.1, Gnetetskiy S.F.1, Sharifullin F.A.1, Fain A.A.1
-
Affiliations:
- Sklifosovsky Research Institute of Emergency Medicine
- Issue: Vol 29, No 4 (2022)
- Pages: 367-378
- Section: Original study articles
- Submitted: 22.11.2022
- Accepted: 26.12.2022
- Published: 15.12.2022
- URL: https://journals.eco-vector.com/0869-8678/article/view/114784
- DOI: https://doi.org/10.17816/vto114784
- ID: 114784
Cite item
Abstract
BACKGROUND: A proximal humerus fracture (PHF) is quite common and accounts for approximately 5% of all fractures. During surgery, these fractures make it difficult to correctly reattach the bone fragments. Various special techniques are needed for repositioning and stable fixation of the fragments. When considering the most effective ways to facilitate fracture repositioning and prevent secondary displacement, we paid attention to the publications on the use of the fibula graft.
AIM: To evaluate the effectiveness of a new allogeneic bone-collagen graft from the fibula head in PHF osteosynthesis with a plate having angular stability in conditions of bone tissue deficit.
MATERIALS AND METHODS: An original bone-collagen allogeneic graft from the proximal part of the fibula was developed. We carried out a comparative analysis of the treatment results in patients operated on using the fibula head allograft (group O — 48 patients, subgroup O1 - 35 patients; period - not less than 1 year after surgery) and the group without using augmentation graft (group K — 32 patients). The results were assessed using clinical, radiological, and standardized Constant Shoulder Score; the statistical analysis was also performed.
RESULTS: No patient in group O developed secondary dislocation, while in group K it was noted in 5 (16%) patients. Head collapse developed in 3 patients (7%) in group O and 8 (25%) in group K. Surgery time was shorter in group O than in group K. The mean Constant Scholder Score in subgroup O1 was 78 and in group K 70. Thinning in the cortical layer of the graft and the border disappearance between the spongy part of the graft and the bone tissue of the humeral head were noted in all patients during multispiral CT scanning over time, which was considered a sign of graft remodeling and lysis.
CONCLUSION: In severe PHF with bone deficit, it is possible to perform organ preseration surgery regardless of the patient’s age and obtain functional results satisfying both the patient and the physician. Our suggested method of severe PHF surgical treatment combined with bone deficit facilitates repositioning, reduces operation time, and decreases the number of complications.
Full Text
About the authors
Aleksandr Yu. Vaza
Sklifosovsky Research Institute of Emergency Medicine
Email: VazaAU@sklif.mos.ru
ORCID iD: 0000-0003-4581-449X
SPIN-code: 9664-0137
MD, Cand. Sci. (Med.), Leading Researcher, Traumatologist-Orthopedist
Russian Federation, MoscowAleksey M. Fain
Sklifosovsky Research Institute of Emergency Medicine
Email: FainAM@sklif.mos.ru
ORCID iD: 0000-0001-8616-920X
SPIN-code: 2232-0852
MD, Dr. Sci. (Med.), Professor, Traumatologist-Orthopedist
Russian Federation, MoscowKristina I. Skuratovskaya
Sklifosovsky Research Institute of Emergency Medicine
Author for correspondence.
Email: kris-sku@yandex.ru
ORCID iD: 0000-0003-3074-453X
SPIN-code: 6768-3041
Junior Researcher, Traumatologist-Orthopedist
Russian Federation, MoscowRoman S. Titov
Sklifosovsky Research Institute of Emergency Medicine
Email: TitovRS@sklif.mos.ru
ORCID iD: 0000-0002-2960-8736
MD, Cand. Sci. (Med.), Senior Researcher, Traumatologist-Orthopedist
Russian Federation, MoscowNatalya V. Borovkova
Sklifosovsky Research Institute of Emergency Medicine
Email: BorovkovaNV@sklif.mos.ru
ORCID iD: 0000-0002-8897-7523
SPIN-code: 9339-2800
MD, Dr. Sci. (Med.), Professor
Russian Federation, MoscowSergey F. Gnetetskiy
Sklifosovsky Research Institute of Emergency Medicine
Email: GnetetskiySF@sklif.mos.ru
ORCID iD: 0000-0001-9932-1653
SPIN-code: 5800-3960
MD, Dr. Sci. (Med.), Leading Researcher, Traumatologist-Orthopedist
Russian Federation, MoscowFaat A.-K. Sharifullin
Sklifosovsky Research Institute of Emergency Medicine
Email: SharifullinVA@sklif.mos.ru
ORCID iD: 0000-0001-7483-7899
SPIN-code: 8806-0316
MD, Dr. Sci. (Med.), Chief Researcher
Russian Federation, MoscowAnton A. Fain
Sklifosovsky Research Institute of Emergency Medicine
Email: FaynAA@sklif.mos.ru
SPIN-code: 1226-9372
Radiologist
Russian Federation, MoscowReferences
- Baron JA, Karagas M, Barrett J, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. 1996;7(6):612–618. doi: 10.1097/00001648-199611000-00008
- Walsh S, Reindl R, Harvey E, et al. Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech (Bristol, Avon). 2006;21(10):1027–1031. doi: 10.1016/j.clinbiomech.2006.06.005
- Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011;42(4):408–413. doi: 10.1016/j.injury.2010.11.058
- José MMG, Juan SP, Alejandro CS. Updated Classification System for Proximal Humeral Fractures. Clin Med Res. 2009;7(1–2):32–44. doi: 10.3121/cmr.2009.779
- Handoll HHG, Ollivere BJ, Rollins KE. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2012;12:CD000434. doi: 10.1002/14651858.CD000434.pub3
- Patent RUS N 2341222/2008. Pokhvashchev DP, Klyukvin IYu. Osteosintez proksimal’nogo otdela plechevoi kosti. Available from: https://findpatent.ru/patent/234/2341222.html. Accessed: 06.03.2023. (In Russ).
- Biermann N, Wolf CP, Wolfgäng B, et al. Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies. Arch Orthop Trauma Surg. 2019;139(8):1075–1099. doi: 10.1007/s00402-019-03162-2
- Tan E, Lie D, Wong MK. Early outcomes of proximal humerus fracture fixation with locking plate and intramedullary fibular strut graft. Orthopedics. 2014;37(9):822–827. doi: 10.3928/01477447-20140825-60
- Chen H, Ji X, Gao Y, et al. Comparison of intramedullary fibular allograft with locking compression plate versus shoulder hemi-arthroplasty for repair of osteoporotic four-part proximal humerus fracture: Consecutive, prospective, controlled, and comparative study. Orthop Traumatol Surg Res. 2016;102(3):287–292. doi: 10.1016/j.otsr.2015.12.021
- Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.
- Patent RUS N 2721873С1/2019. Vaza AYu, Fain AM, Borovkova NV, et al. Allogennyi kombinirovannyi kostnyi transplantat dlya lecheniya slozhnykh perelomov proksimal’nogo otdela plechevoi kosti, sposob ego polucheniya. Available from: https://findpatent.ru/patent/234/2341222.html. Accessed: 06.03.2023. (In Russ).
- Vaza AYu, Makarov MS, Slastinin VV, et al. Efficiency of allogenic platelet-rich plasma, combined with collagen, in rat’s humerus injury healing. Transplantologiya. The Russian Journal of Transplantation. 2016;2:36–44. (In Russ).
- Patent RUS N RU 2712298/28.01.2020. Titov RS, Fain AM, Vaza AYu, et al. Sposob osteosinteza pri perelomakh proksimal’nogo otdela plechevoi kosti. Available from: https://i.moscow/patents/ru2712298c1_20200128. Accessed: 06.03.2023. (In Russ).