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Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2019, Number 2

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Ortho-tips 2019; 15 (2)

Allograft femoral head augmentation and plate fixation in older adults with Neer 3-4 proximal humerus fractures and their predictors of failure

López CRE, Krappinger D, Riedl M, Knierzinger D, Wahler W, Kralinger F

Language: Spanish
References: 16
Page: 130-139
PDF size: 190.75 Kb.


ABSTRACT

Introduction: Proximal humerus fracture is the third most frequent fragility fracture. Poor bone quality and older age are associated with a high failure rate. The objective of this study was to evaluate the predictors of failure in proximal humerus fractures Neer 3 and 4 treated with plate fixation and plate fixation + augmentation with femoral head allograft. Material and methods: We include 30 patients over 65 years of age with proximal humerus fractures of 3 and 4 fragments treated with Proximal Humeral Internal Locking System (PHILOS) (9 patients treated with augmentation and 21 patients without augmentation). We evaluate as risk factors for complications the: Deltoid Tuberosity Index, age, type of fracture, extent of calcar, impaction in varus, size of femoral head fragment (FHF), reduction and time to surgery. Results: The average age of the sample was 78.1 years, 63% found poor bone quality (DTI less than 1.44) were shown to be risk factors for complications, age p = 0.03, absence of calcar reconstruction p = 0.05 and absence of augmentation p = 0.05. Conclusion: We can conclude that the use of osteosynthesis with plaque in the elderly should be performed only in selected patients, due to the high number of complications. We confirm that the older you are, the higher the failure rate in osteosynthesis. The use of augmentation with structural allograft is useful in these cases, but it does not replace the anatomical reduction of calcar.


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