Open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with locking plate and intramedullary allograft: A retrospective study

Background This retrospective clinical study aims to compare the functional and radiological outcomes after open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with both locking plate and intramedullary graft. Methods Forty-seven patients with proximal humerus fractures were treated with either open reduction and internal fixation (25 cases) or minimally invasive plate osteosynthesis (22 cases) and evaluated retrospectively with a minimum follow-up of 12 months. Thirty-one fresh-frozen fibulae and 16 lyophilized tibia allografts were used for augmentation. Change of both neck-shaft angle and humeral head height were evaluated radiologically. Functional outcomes were assessed using Disabilities of the Arm, Shoulder and Hand Score (DASH), Absolute Constant-Murley Score (CSabs), Relative Constant-Murley Score (CSrel), and Individual Relative Constant-Murley Score (CSindiv). Results Follow-up period and age for open reduction and internal fixation/minimally invasive plate osteosynthesis were 27.4 +/- 16.2/29.6 +/- 17.6 months and 60.5 +/- 13.7/66.3 +/- 11.7 years. CSabs, CSrel, and CSindiv were 57.3 +/- 21.2/52.4 +/- 18.9, 73 +/- 24.1/73.9 +/- 23.4, and 69.6 +/- 24.8/64 +/- 25.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p >= 0.409. DASH was 14.8 +/- 12.5/18.7 +/- 14.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p = 0.324. Decrease of neck-shaft angle and humeral head height was 7.8 +/- 9.4/8.2 +/- 15.6 degrees and 0.6 +/- 5.5/1.4 +/- 2.6 mm for open reduction and internal fixation/minimally invasive plate osteosynthesis, p >= 0.380. Surgical time was 165.8 +/- 77.6/84.7 +/- 38.1 min for open reduction and internal fixation/minimally invasive plate osteosynthesis, p < 0.001. Conclusions Locked plating with intramedullary graft augmentation of unstable proximal humerus fractures demonstrates similar functional and radiological outcomes when comparing open reduction and internal fixation with minimally invasive plate osteosynthesis. However, minimally invasive plate osteosynthesis is related to significantly shorter surgical time versus open reduction and internal fixation.