Results of surgical management of valgus-impacted proximal humerus fractures with structural allografts

Abstract

Objective: The aim of this study was to clinically and radiologically evaluate patients treated with plate osteosynthesis with structural allografts for severely valgus-impacted fractures of the proximal humerus. Methods: The study included 10 patients (average age: 57 years; range: 34 to 77 years) with valgus-impacted Neer Type 4 proximal humerus fractures. Fractures were classified according to the Robinson classification. Patients were called for an up-to-date examination and evaluated radiologically and clinically with Constant and DASH scores. Results: Average follow-up period was 22.5 +/- 12.2 (range: 12 to 50) months. Average DASH score at the final follow-up was 7.6 +/- 4.5 (range: 2.5 to 16.7) and average Constant score was 87.7 +/- 4.4 (range: 83 to 94). None of the cases had early or late head collapse. There was no avascular necrosis. One early screw penetration was observed. Conclusion: Surgical treatment of valgus-impacted proximal humerus fractures achieved successful results. However, the cavity under the humeral head may lead to failure due to mechanical insufficiency. Plate osteosynthesis with structural allografts warrants initial mechanical support until union, thus avoiding complications related to head collapse.