Locking plate in the treatment of proximal humeral fractures involving humeral calcar: Effective support, complications and functional recovery / 中国组织工程研究

ABSTRACT

BACKGROUND: Saving the humeral head is a challenge when the proximal humerus is fracture in orthopedic trauma, and how to obtain medial column support is a hot topic in recent years. OBJECTIVE: To summarize the general concept, clinical significance and function, the common injury mechanism of humeral calcar, and the progress using locking plate so as to improve the clinicians' understanding for the humeral calcar and to reduce the occurrence of surgical complications. METHODS: From 2004 to 2019, Wanfang, CNKI, VIP, PubMed, Web of Science, and Springer Link about the treatment and research progress of proximal medial wall of the humerus were searched by the first author. The key words were "proximal humeral fracture, Philos, intermedial screw, calcar screw, fibular allograft, middle support" in English, and "proximal humeral fracture, humeral spur, medial column, plate, fibular allograft" in Chinese. The references were retrieved by hand. Finally, 51 studies were used for review according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) The range of the humeral calcar region is still unclear. There is no uniform classification standard for fractures involving the humeral calcar region. X-ray films show that calcar fracture patterns are often inconsistent with the actual fracture situation, which is often a complex fracture. Lack of understanding and paying litter attention to the humeral calcar region is the main reason of iatrogenic injury and the failure to get a good repair. (2) Treatment using the locking plate is still the preferred method for proximal humerus fracture. Meanwhile, it is a feasible method that using the screw, the allogeneic iliac bone graft, the bone cement or the medial plate to reconstruct the medial column if there is a "repairable medial wall". Getting anatomical reduction of the internal wall and effective support of the medial column during operation can help to reduce postoperative complications. However, the use of the medial buttress plate requires further research to verify. It is critical important to repair the rotator cuff for the medial column support. (3) The range of the humeral calcar region needs to be unified. Understanding the humerus calcar is essential for the treatment of proximal humeral fracture. Only by mastering the fracture mode of the humerus calcar and choosing the most appropriate surgical procedure before surgery, meanwhile, achieving anatomical reduction of the medial wall and the effective support of the medial column during operation can reduce the postoperative complications of the fracture. Repairing of the rotator cuff carefully during operation is indispensable for patients to obtain better shoulder function.