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Objective: To review the research progress in the treatment of proximal humeral fractures with fibular allograft and locking plate. Methods: The literature about the treatment of proximal humeral fractures with fibular allograft and locking plate was reviewed and analyzed from the aspects such as the biomechanics, imaging prognosis, and clinical prognosis. Results: Fibular allograft and locking plate can provide effective medial support for proximal humeral fracture and increase the strength of internal fixation system. Compared with locking plate, fibular allograft combined with locking plate can maintain better humeral neck-shaft angle and the humeral head height after operation in the treatment of proximal humeral fractures, and has better shoulder mobility and shoulder joint function, and does not increase the risk of complications. Conclusion: Fibular allograft combined with locking plate may be a new and effective treatment for proximal humeral fractures. However, the long-term follow-up results are insufficient, the final outcome of fibula is uncertain, and the long-term potential adverse reactions caused by this treatment are still indefinite.
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BACKGROUND: The best treatment of proximal humeral fracture has always been controversial. Open reduction and internal fixation with locking plate is a common method for the treatment of proximal humeral fractures. In recent years, many studies have pointed out that locking plate combined with fibular allograft can obtain better rigid structure. OBJECTIVE: To evaluate the clinical efficacy of locking plate and locking plate combined with fibular allograft in the treatment of proximal humeral fractures. METHODS: CNKI, Wanfang database, VIP, PubMed, EMBASE, and Cochrane Library were searched for articles concerning locking plate and locking plate combined with fibular allograft for proximal humeral fractures published from inception to January 2020 for quality evaluation. International Cochrane collaboration RevMan 5.0 software was used for meta-analysis. The difference in American shoulder and elbow surgeons score, Constant score, humeral head height loss value, the change of humeral neck angle, incidence of postoperative complications, secondary surgery rate, screw cutout rate, and humeral head necrosis rate were compared between the locking plate group and locking plate combined with fibula group. RESULTS AND CONCLUSION: (1) Eight studies were included with a total of 623 patients. (2) Results analysis showed that there were significant differences between the locking plate group and locking plate combined with fibula group in American shoulder and elbow surgeons score (95%CI:4.29-6.84, P 0.05) and humeral head necrosis rate(95%CI:0.41-2.11, P > 0.05). (4) Locking plate combined with fibula with simple locking plate in American shoulder and elbow surgeons score, Constant score, humeral head height loss value, neck stem Angle values, the incidence of postoperative complications, and screw cutout rate has a better clinical effect, but does not have significant difference in the second operation rate or humeral head avascular necrosis..
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Objective To compare differences in mechanical stability of intramedullary fibular allograft with cannulated screw (modified method) and cannulated screw alone (conventional method) for fixing young and middle-aged Pauwels Ⅰ, Ⅱ, Ⅲ femoral neck fractures. Methods Models of Pauwels Ⅰ, Ⅱ, Ⅲ femoral neck fracture fixed by conventional method and modified method were constructed. Stress distributions on weight-bearing area of the femoral cortical bone shell and the end of femoral neck fracture, as well as shear stress distributions on cortical bone shell of the femoral head and femoral neck fracture surface were analyzed, the maximum principal strain cloud maps of the femur in coronal position were drawn according to the predicted data, and the displacements of femoral neck fracture end between two groups were compared. Results The shear stress distributions on cortical bone shell of the femoral head in two directions (S12, S13) showed that femoral neck fractures fixed by modified method was superior or close to that by conventional method. Besides, the shear stress distributions on fracture surface of the femoral neck in two directions (S12, S23) showed that modified internal fixation was superior to conventional internal fixation. The displacements of femoral neck fracture end in Pauwels Ⅱ and Ⅲ fracture fixed by conventional method were greater than those by modified method and the displacements of Pauwels Ⅱ fracture fixed by conventional method were obviously larger than those of Pauwels Ⅱ fracture fixed by modified method. But Pauwels Ⅰ fracture fixed by modified method showed a larger displacement than that fixed by conventional method. Conclusions Modified method is more suitable for fixing femoral neck fracture with large angles (Pauwels Ⅱ and Ⅲ fracture), and conventional method is more suitable for fixing neck fracture with small angles (Pauwels Ⅰ fracture).
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BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.
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Humans , Allografts , Arm , Classification , Joint Dislocations , Elbow , Follow-Up Studies , Hand , Humerus , Neck , Prospective Studies , ShoulderABSTRACT
BACKGROUND: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. METHODS: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. RESULTS: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was 127.5°. CONCLUSIONS: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.
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In this retrospective study, surgical results of four patients with sacral tumors having disparate pathologic diagnoses, who were treated with partial or total sacrectomy and lumbopelvic stabilization were abstracted. Two patients were treated with partial sacral resection and two patients were treated with total sacrectomy and spinopelvic fixation. Fixation methods included spinopelvic fixation with rods and screws in two cases, reconstruction plate in one case, and fresh frozen allografts in two cases. Fibular allografts used for reconstruction accelerated bony union and enhanced the stability in two cases. Addition of polymethyl methacrylate in the cavity in the case of a giant cell tumor had a positive stabilizing effect on fixation. As a result, we can conclude that mechanical instability after sacral resection can be stabilized securely with lumbopelvic fixation and polymethyl methacrylate application or addition of fresh frozen allografts between the rods can augment the stability of the reconstruction.
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Humans , Allografts , Diagnosis , Giant Cell Tumors , Polymethyl Methacrylate , Retrospective StudiesABSTRACT
Objective To explore the effect of improved surgical method of intramedullary fibular allograft together with cannulated screw fixation combined with blood-activating and stasis-resolving Chinese medicine on the quality of life (QOL) of young and middle-aged fresh femoral neck fractures at intermediate stage. Methods A retrospective analysis was carried out in the articular orthopedics department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine. The study involved 80 cases of young and middle-aged fresh femoral neck fractures receiving intramedullary fibular allograft together with cannulated screw fixation, and 50 qualified cases receiving cannulated screw fixation alone ( control group) . After the operation, all of the patients were given oral use of blood-activating and stasis-resolving Chinese medicine. After the last follow-up, Harris hip scoring, SF-36 scoring and radiographic evaluation were performed for the evaluation of clinical efficacy. Results The clinical application of intramedullary fibular allograft together with cannulated screw fixation combined with Chinese medicine was fulfilled in 80 hips of 80 cases. The follow-up period ranged from 48 to 84 months, averaging 62.68 ± 12.43 months. The improved surgical method group had an excellent and good rate of 93.75%, presented excellent-grade Harris scores and SF-36 scores, and had higher QOL scores than the control group (P<0.05) . After treatment, the two groups had statistically significant differences in the scores of SF-36 items of physical function ( PF) , bodily pain ( BP) , mental health ( MH) , vitality ( VT) , and general health ( GH) ( P<0.05 or P<0.01) , and also had significant differences in Harris scoring of pain, function and daily activities as well as the joint range-of-motion ( P<0.05 or P<0.01) . Conclusion The improved surgical method of intramedullary fibular allograft together with cannulated screw fixation combined with blood-activating and stasis-resolving Chinese medicine shows satisfactory therapeutic effect for young and middle-aged fresh femoral neck fractures at intermediate stages, which has the advantages of lower collapse rate after femoral head necrosis, less joint replacement, higher scores of the quality of life and Harris scoring, and better radiographic indicators than cannulated screw fixation alone.
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OBJECTIVE: This consecutive retrospective study was designed to analyze and to compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using a fibular and femur allograft with anterior cervical plating. METHODS: A total of 88 consecutive patients suffering from cervical degenerative disc disease (DDD) who were treated with ACDF from September 2007 to August 2010 were enrolled in this study. Thirty-seven patients (58 segments) underwent anterior interbody fusion with a femur allograft, and 51 patients (64 segments) were treated with a fibular allograft. The mean follow-up period was 16.0 (range, 12-25) months in the femur group and 19.5 (range, 14-39) months in the fibular group. Cage fracture and breakage, subsidence rate, fusion rate, segmental angle and height and disc height were assessed by using radiography. Clinical outcomes were assessed using a visual analog scale and neck disability index. RESULTS: At 12 months postoperatively, cage fracture and breakage had occurred in 3.4% (2/58) and 7.4% (4/58) of the patients in the femur group, respectively, and 21.9% (14/64) and 31.3% (20/64) of the patients in the fibular group, respectively (p<0.05). Subsidence was noted in 43.1% (25/58) of the femur group and in 50.5% (32/64) of the fibular group. No difference in improvements in the clinical outcome between the two groups was observed. CONCLUSION: The femur allograft showed good results in subsidence and radiologic parameters, and sustained the original cage shape more effectively than the fibular allograft. The present study suggests that the femur allograft may be a good choice as a fusion substitute for the treatment of cervical DDD.
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Humans , Dichlorodiphenyldichloroethane , Diskectomy , Femur , Follow-Up Studies , Neck , Retrospective Studies , Stress, Psychological , Transplantation, HomologousABSTRACT
OBJECTIVE: The authors performed instrumented anterior cervical fusion with either iliac autograft or fibular allograft for various clinical entities. The purposes of the study are to compare the fusion rate and the time to fusion according to graft material, and to identify the factors affecting fusion. METHOD:57 patients underwent instrumented anterior cervical fusion during 3 years between Jan. 1995 and Dec. 1997, among them 31 patients with iliac autograft(autograft group), and 26 patients with freeze-dried fibular allograft (allograft group). The clinical entities were trauma(n=0), soft disc herniation(n=), spondylotic radiculopathy(n=1), spondylotic myelopathy(n=6), and ossified posterior longitudinal ligament(n=). The method of fusion was either interbody fusion confined to disc space or strut fusion after corpectomy. Outcomes were assessed for fusion status and time to fusion, and comparison between autograft group versus allograft group. RESULT: Between autograft and allograft group there were no differences in distribution of perioperative clinical variables such as patients' age and gender, clinical entity, method of fusion, and length of fusion as determined by the number of disc space fused. Mean follow-up period was 19 months(range 10-28 months) in autograft group and 16 months(range 8-22 months) in allograft group. The fusion rate was 90% in autograft group and 85% in allograft group(p=.691). The median time to fusion was 7 months in autograft group and 15 months in allograft group(p<0.001). The perioperative variables affecting fusion, defined as those being significantly associated with the time to fusion, were the graft material(p=.000) and the length of fusion(p=.007). The rate of graft-related complications including donor-site morbidity was 41% in autograft group and 8% in allograft group. CONCLUSION: It is concluded that the use of freeze-dried fibular allograft in instrumented anterior cervical fusion is, though the time to fusion is delayed more than two times, as an effective way as the use of iliac autograft to achieve fusion, and is a better way to ameliorate graft-related complications.