Abstract
Introduction:
Proximal humerus fracture is the most common fracture in older population, accounting for 5 - 6% of all fractures. Most of humeral head fracture can be treated conservatively, but fractures with Neer-3 or Neer-4 are clinically treated by surgeries. The use of fibular strut graft help reduces the issues of ORIF in proximal humerus fractures including failure of implant, loss of reduction, malunion or non-union, osteonecrosis, impingement syndrome, screw loosening, screw penetration to the joint, and varus collapse. We present a case of closed proximal humerus fracture treated with fibular strut graft insertion in shoulder reconstruction with internal fixation using plate and screw.
Case Presentation:
A 64-year-old female was diagnosed with closed fracture at left proximal humerus Neer three-part Tcherne classification type 1 without neurological deficit. The collided humeral head fragment was released with periosteal elevator to revert the medial calcar portion. The fibular strut graft was placed into the humeral shaft. The reduction was temporarily stabilized using Kirschner wire (k-wire) and final fixation was done with five fixed-angle screw.
Discussion:
The mechanism of the injury in proximal humeral fractures often involve simple low-energy falls from standing height. Aided by gravity, reduction can be achieved in two-part fracture by bringing the injured arm to a favorable orthograde position, pulling the shaft downwards, and counteracting the displacing force. As implemented in this procedure, plate fixation has several advantages, including providing multiple points of fixation within the humeral head, reduction and fixation using suture holes in the plate, and implant potential in assisting fracture reduction. The use of fibular strut graft was found to significantly reduce varus malalignment and loss of humeral head height.
Conclusion:
Proximal humerus fractures often occur in osteoporotic older population. Surgery is indicated in severe fragmented fractures. Open reduction and internal fixation with screw and plate can be done to fixate the fragmented fracture. The use of fibular strut graft help give support in the calcar region and prevent varus displacement.