Restoration of Medial Hinge in Acute Complex Proximal Humeral Fractures using Intra-Medullary Strut Allograft

Background Proximal humerus fractures with medial column comminution/collapse often pose management dilemmas to the treating surgeon. Medial column mechanical support of these fractures plays a significant role in the ultimate stability of fixation until healing. Methods Twelve patients (four men and eight women) with unstable proximal humerus fractures were taken up for study. The fractures were stabilized with intramedullary strut allograft and locking plate (PHILOS) by a deltoid splitting approach. The outcome was assessed clinically by Oxford Shoulder Score and radiologically by measuring the head shaft angle at follow-up. Results The mean age of the patients was 65 years (range 54 years to 72 years) with the dominant arm affected in nine. All fractures progressed to union at an average of 4 months and 15 days (3 months to 11 months). At final follow-up (average 29.7 months), all patients had good functional outcome, with an average Oxford Shoulder Score of 19.2 (12 to 32). The average loss of head shaft angle was 6° (0° to 8°). Conclusion The technique has potential technical advantages in the management of proximal humeral fractures with medial column comminution/collapse. The rate of union has been encouraging and we recommend it as a method of treatment.