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Introduction <p>To study the radiological and functional outcomes of complex four-part proximal humerus fractures treated with open reduction and plate fixation with fibular strut graft augmentation.</p> Materials and methods <p>We retrospectively analyzed 15 patients with unstable four-part proximal humerus fractures between 2021 and 2023, with a mean follow-up of 1&#xa0;year. All patients underwent open reduction and plate fixation with a fibular strut graft augmentation. Radiological outcomes were the neck shaft angle (NSA), greater tuberosity (GT) to the articular surface (AS) distance, and the medial hinge reduction. Functional outcomes included the American Shoulder and Elbow Surgeons (ASES) score, DASH, and Constant-Murley (CM) score.</p> Results <p>The mean age was 49.6&#xa0;years (39–60), and all fractures were united by 14&#xa0;weeks (12–18). The mean NSA was 137.33° (125–149) and the mean GT-AS distance was 5.6&#xa0;mm (-2 to 8.8) at one year. The mean ASES, DASH, and CM scores at one year were 87.6, 7.05, and 75.2, respectively. The two patients with initial NSA &lt; 130° and GT higher than the AS had poor functional outcomes and one patient had a screw back out; however, there was no loss in the reduction in all patients.</p> Conclusion <p>Using a locking plate combined with a fibula autograft seems to provide a more stable structure without affecting the viability of the head’s articular surface by increasing medial hinge support in unstable four-part proximal humerus fractures. Consequently, this may lead to improved clinical outcomes and reduced complication rates but is no substitute for adequate reduction.</p>

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Clinico-radiological outcomes of four-part proximal humerus fracture fixation with fibular strut graft augmentation

  • 期刊论文

  • 发表日期：

    2025年6月1日

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  • Shakti Prasad Das,
  • Suhas Sondur,
  • Swatantra Mohanty,
  • Sayashi Roy

摘要

Introduction

To study the radiological and functional outcomes of complex four-part proximal humerus fractures treated with open reduction and plate fixation with fibular strut graft augmentation.

Materials and methods

We retrospectively analyzed 15 patients with unstable four-part proximal humerus fractures between 2021 and 2023, with a mean follow-up of 1 year. All patients underwent open reduction and plate fixation with a fibular strut graft augmentation. Radiological outcomes were the neck shaft angle (NSA), greater tuberosity (GT) to the articular surface (AS) distance, and the medial hinge reduction. Functional outcomes included the American Shoulder and Elbow Surgeons (ASES) score, DASH, and Constant-Murley (CM) score.

Results

The mean age was 49.6 years (39–60), and all fractures were united by 14 weeks (12–18). The mean NSA was 137.33° (125–149) and the mean GT-AS distance was 5.6 mm (-2 to 8.8) at one year. The mean ASES, DASH, and CM scores at one year were 87.6, 7.05, and 75.2, respectively. The two patients with initial NSA < 130° and GT higher than the AS had poor functional outcomes and one patient had a screw back out; however, there was no loss in the reduction in all patients.

Conclusion

Using a locking plate combined with a fibula autograft seems to provide a more stable structure without affecting the viability of the head’s articular surface by increasing medial hinge support in unstable four-part proximal humerus fractures. Consequently, this may lead to improved clinical outcomes and reduced complication rates but is no substitute for adequate reduction.