![]() ![]() Nine patients who did not meet the inclusion criteria underwent hemiarthroplasty. Any patient meeting the above criteria who underwent this procedure during the study period was considered for inclusion. Patients who were unwilling or unable to participate in the postoperative rehabilitation program due to physical or mental illness were contraindicated. All patients with an acute, displaced PHF having cortical comminution in the region of the surgical neck were considered for this procedure. We retrospectively reviewed 48 patients with displaced PHFs treated with a locking plate and endosteal strut augment between November 2006 and June 2009. Our purposes were to (1) determine function (Disabilities of the Arm, Shoulder, and Hand, SF-36, and Constant-Murley scores) of patients with displaced PHFs treated with a lateral locking plate and endosteal strut (2) determine whether these scores vary based on Neer fracture type and (3) report the incidence of complications associated with this technique. Use of an allograft strut has been suggested as a means of establishing a second column of support when neck comminution is present. Comminution of the surgical neck prohibits establishing support via cortical abutment, however. Establishing medial column support appears to reduce these complications and enhance functional results. The most frequent are screw cutout with intra-articular penetration and varus collapse. However, complication rates for the treatment of PHFs have ranged from 9% to 36% and are reportedly highest in elderly patients. The introduction of locking-plate technology has renewed interest in plate fixation for treating PHFs because these implants provide a theoretical advantage toward maintaining stable fixation in osteoporotic bone. Open reduction and internal fixation (ORIF) reportedly restores shoulder function to 96% of an uninjured extremity when an anatomic or near-anatomic reduction is maintained until healing, and ON is avoided. Arthroplasty procedures provide reliable pain relief but inconsistent motion. Some have advocated for hemiarthroplasty because of the high risk of osteonecrosis (ON) and loss of fixation with traditional plating techniques. Each of the surgical options, such as plate fixation, intramedullary nailing, percutaneous pinning, and tension band wiring, is associated with unique complications, and there is no consensus as to which treatment is best. Nonoperative treatment results in minimal pain but with reduced function reportedly comparable to that of shoulder fusion. More than 80% of these can be treated nonoperatively, but displaced three- and four-part fractures remain a clinical challenge. Proximal humerus fractures (PHFs) account for 5% of all fractures and are increasing in frequency as the population ages. ![]()
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