Allografts are not necessary for displaced proximal humeral fractures in patients less than 65 years old,a retrospective cohort study |
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| Institution: | 1. Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Lane 37, Chengdu, 610041, Sichuan Province, China;2. Shanghai Jiao Tong University Affiliated Sixth People''s Hospital, 600 Yishan Road, Shanghai, 200235, China;1. Abteilung Orthopädie und Traumatologie BKH St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria;2. Orthopädie, Knie & Fuß im Zentrum, Innrain 2, 6020 Innsbruck, Austria;3. Krems Donauuniversität Orthopädie und Traumatologie, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria;4. Klinik für Orthopädie und Traumatologie Innsbruck, Anichstraße 42, 6020 Innsbruck, Austria;1. St Thomas’ Hospital, London SE1 7EH;2. Guy''s Hospital, St Thomas Street, London SE1 9RT;1. Ankara Y?ld?r?m Beyaz?t University, Medical Faculty, Department of Histology and Embryology, Ankara, Turkey;2. Health Sciences University, Gulhane Health Sciences Institute,Stem Cell Laboratory, Ankara, Turkey;1. Department of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP United Kingdom;2. Barts Bone & Joint Health, The Royal London Hospital, Whitechapel Rd, London, E1 1FR United Kingdom;1. Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany;2. Laboratory for Biomechanics, BG Hospital Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany;3. Hochschule der DGUV (HGU) – University of Applied Sciences, Seilerweg 54, 10117 Bad Hersfeld, Germany;4. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;1. Royal Sussex County Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, United Kingdom;2. Department of Trauma and Orthopaedics, St Georges University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom;3. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States |
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| Abstract: | IntroductionDisplaced proximal humeral fractures (PHF) are frequently treated with locking plates to achieve osteosynthesis. Bone grafts are used as augmentation techniques to improve stability in osteoporotic patients. However, there has been little research into whether bone grafts are necessary for patients younger than 65 years old. This study compared radiographic and clinical outcomes between PHFs augmented with bone grafts or not in a younger population.MethodsBetween January 2016 and June 2020, 91 patients treated with a locking plate alone (LP), and 101 patients treated with locking plates augmented with bone grafts (BG) were analyzed. Potential confounding factors for outcomes were adjusted by propensity score-matching analyses. For the retrospective cohort study, 62 patients from each group were evaluated for radiographic outcomes and clinical outcomes and compared.ResultsSixth-two patients in each group, both with a mean age of 52 years old, were with a mean follow-up time of 25 months in the LP group and 26 months in the BG group. There was no difference in demographic or surgical characteristics between the two groups after propensity score-matching. With regard to radiographic outcomes, the changes in neck-shaft angle (?5.1 ± 4.9 vs. ?3.1 ± 5.3, p = 0.015) and humeral head height (?1.5 ± 2.5 vs. ?0.4 ± 2.7, p = 0.002) were more obvious in the BG group. However, regarding functional outcomes, there were no significant differences between the two groups in DASH score, Constant–Murley score, or VAS score. Moreover, the complication rate was not significantly different between two groups.DiscussionAllografts only provide minor improvements of stability in radiography for patients less than 65 years old after locking plate fixation of PHFs, but don't improve shoulder function, relieve pain or reduce complications. We concluded that allografts are unnecessary for younger patients with displaced PHFs. |
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