Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures.

Abstract

BACKGROUND:

We sought to examine fracture settling and screw penetration after open reduction-internal fixation of 2-, 3-, and 4-part proximal humeral fractures and determine whether the use of calcium phosphate cement reduced these unwanted complications.

METHODS:

We performed a retrospective study of prospective data. Inclusion criteria included patient age of 18 years or older and an acute traumatic fracture of the proximal humerus that was treated with open reduction-internal fixation with a locked plate. Metaphyseal defects were treated with 1 of 3 strategies: no augmentation, augmentation with cancellous chips, or augmentation with calcium phosphate cement. Various radiographic measurements were made at each follow-up visit to assess for humeral head settling or collapse. Overall, 92 patients (81%) met the inclusion criteria and form the basis of this study. Augmentation type included 29 patients (32%) with cancellous chips, 27 (29%) with calcium phosphate cement, and 36 (39%) with no augmentation.

RESULTS:

There were no statistical differences among the groups with respect to patient age, sex, and fracture type. At the 3, 6, and 12-month follow-up visits, there was less humeral head settling with calcium phosphate cement compared with repair with no augmentation or with cancellous chips. Findings of joint penetration were significant among patients treated with plates and screws alone versus those augmented with calcium phosphate (P = .02) and for those augmented with cancellous chips versus those augmented with calcium phosphate (P = .009).

CONCLUSION:

Augmentation with calcium phosphate cement in the treatment of proximal humeral fractures with locked plates decreased fracture settling and significantly decreased intra-articular screw penetration.

• Authors: Kenneth A Egol, Michelle T Sugi, Crispin C Ong, Nicole Montero, Roy Davidovitch, Joseph D Zuckerman
• Journal: Journal of shoulder and elbow surgery (J Shoulder Elbow Surg) Vol. 21 Issue 6 Pg. 741-8 (Jun 2012) ISSN: 1532-6500 [Electronic] United States
• PMID: 22192764 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Chemical References

• Bone Cements
• Calcium Phosphates
• calcium phosphate

Topics

• Adult
• Aged
• Aged, 80 and over
• Bone Cements (therapeutic use)
• Bone Plates
• Bone Screws
• Calcium Phosphates (therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Postoperative Complications (prevention & control)
• Retrospective Studies
• Shoulder Fractures (surgery)