wetenschapsdag 2023 | 93 Sessie 3b: Chirurgie Voorbij de Scalpel x4 Auteurs F.L.J. Opperman, L.S. Blaas, M. Pape, N. Buijs, M. v Sterkenburg, J.Z. Yuan, C.M. Lameijer, R.J. Derksen Abstract titel Fibula allograft in complex three- and four-part proximal humeral fractures in active patients, a matched case-control study Background About 20% of proximal humerus fractures (PHFs) are unstable and/or markedly displaced and therefore require surgery. Locking plate fixation after anatomical reduction has become the current treatment of choice for these fractures in the active population. However, studies have shown complication rates up to 36%, such as loss of reduction and avascular necrosis. To date, data from literature is inconclusive on outcomes following the use of an intramedullary fibula allograft in PHFs, possibly due to the case mix in these studies. It is hypothesized that the use of a fibula allograft is beneficial to prevent secondary displacement of the fracture in cases where the medial hinge is markedly displaced and unstable, resulting in better clinical and patient reported outcomes. Methods In this multicenter matched cohort study, patients with an unstable, displaced PHF, including anatomic neck fractures and significantly displaced surgical neck fractures, were included. Patients that were treated with a locking plate augmented with a fibula allograft were matched to patients who had undergone locking plate reconstruction without allograft. The matches were made based on fracture characteristics, age and performance status. Functional outcomes, Patient Reported Outcome Measures, complications, and radiographic results were compared. Results Twelve patients with fibula allograft augmented osteosyntheses were included and matched to 12 control patients. The mean age was 58 years in the fibula allograft group compared to 62 in the control group. Minimum follow-up was 12 months. DASH score, CSS, abduction and external rotation were significantly better in the fibula allograft group (17.4 ± 8.6 vs 26.1 ± 19.2, p=0.048; 16.5 ± 11.5 vs 19.8 ± 16.5 p=0.040; mean 127° ± 38° vs mean 92° ± 49° p=-0.045; 50° ± 21° vs mean 26° ± 23°, p=0.004). The OSS score tended to favor the fibula group (p=0.105). The VAS was not significantly different between groups (3.1 ± 1.8 vs 1.6 ± 1.9 p=0.439). Radiographic union was reached in 11 patients of the fibula allograft group compared to 8 in the control group (p=0.317). The complication rate was twice as high in the control group (3 versus 7, p=0.214).
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