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Strut Support with Tricortical Iliac Allografts in Unstable Proximal Humerus Fractures: Surgical Indication and New Definition of Poor Medial Column Support
Clin Should Elbow 2019;22:29-36
Published online March 1, 2019;  https://doi.org/10.5397/cise.2019.22.1.29
© 2019 Korean Shoulder and Elbow Society.

Seung-Jin Lee, Yoon-Suk Hyun , Seung-Ha Baek

Department of Orthopadic Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
Correspondence to: Yoon-Suk Hyun
Department of Orthopadic Surgery, Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea
Tel: +82-2-2224-2230~1, Fax: +82-2-489-4391, E-mail: y1205s@hallym.or.kr, ORCID: https://orcid.org/0000-0003-3826-2527
IRB approval: Kangdong Sacred Heart Hospital (No. KANGDONG 2018-08-009-001).
Received September 27, 2018; Revised December 20, 2018; Accepted January 21, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Background: The execution of fibular allograft augmentation in unstable proximal humerus fractures (PHFs) was technically demanding. In this study, the authors evaluated the clinical and radiographic outcomes after tricortical iliac allograft (TIA) augmentation in PHFs.
Methods: We retrospectively assessed 38 PHF patients treated with locking-plate fixation and TIA augmentation. Insertion of a TIA was indicated when an unstable PHF showed a large cavitary defect and poor medial column support after open reduction, regardless of the presence of medial cortical comminution in preoperative images. Radiographic imaging parameters (humeral head height, HHH; humeral neck-shaft angle, HNSA; head mediolateral offset, HMLO; and status of the union), Constant score, and range of motion were evaluated. Patients were grouped according to whether the medial column support after open reduction was poor or not (groups A and B, respectively); clinical outcomes were compared for all parameters.
Results: All fractures healed radiologically (average duration to complete union, 5.8 months). At final evaluation, the average Constant score was 73 points and the mean active forward flexion was 148째. Based on the Paavolainen assessment method, 33 patients had good results and 5 patients showed fair results. The mean loss of reduction was 1.32 mm in HHH and 5.02% in HMLO. None of the parameters evaluated showed a statistically significant difference between the two groups (poor and not poor medial column support).
Conclusions: In unstable PHFs, TIA augmentation can provide good clinical and radiological results when there are poor medial column support and a large cavitary defect after open reduction.
Keywords : Tricortical iliac allograft; Allograft augmentation; Proximal humerus fracture