Thurs., 10/14/10 Upper Extremity, Paper #28, 3:08 pm OTA-2010
Fracture-Site Augmentation with Calcium Phosphate Cement Prevents Screw Penetration following Open Reduction and Internal Fixation (ORIF) of Proximal Humerus Fractures
Kenneth A. Egol, MD; Michelle Sugi, BS; Crispin Ong, MD;
Roy I. Davidovitch, MD; Joseph D. Zuckerman, MD;
NYU Hospital for Joint Diseases, New York, New York, USA
Purpose: The purpose of this study was to evaluate screw settlement, intra-articular penetration, and complications following locked plating of proximal humerus fractures when augmented with a calcium phosphate bone substitute compared to cancellous chips or no augment.
Methods: Between February 2003 and June 2009, 88 patients underwent surgical repair of a displaced proximal humerus fracture. All fractures were operated through a deltopectoral incision and repaired with a locked plate and heavy, nonabsorbable braided sutures. Fracture voids following reduction were treated with 3 different strategies in a nonrandomized manner: no graft, cancellous allograft chips, or calcium phosphate cement. Radiographs were obtained immediately postoperatively and at various time points of healing. Radiographs were examined for “fracture settling” and screw penetration. A Student t test was used to compare change in fracture position during healing between groups.
Results: Patients had minimum 3-, 6-, and 12-month follow-up with radiographs. 32 fractures were augmented with cancellous chips, 20 with calcium phosphate cement, and 32 were repaired with no augment. Radiographically, 98% of factures were healed at latest followup. There was more radiographic settling when no augmentation was used; however, the difference was not significant. There were 11 cases of postoperative joint penetration. Of the 11 patients with joint penetration, 7 were treated with locked plates and screws alone, 3 with cancellous chips, and 1 with calcium phosphate cement. Findings of joint penetration were significant among patients treated with plate and screws alone versus augmented with calcium phosphate (P = 0.05), as well as for those augmented with cancellous chips versus calcium phosphate (P = 0.04).
Conclusion: We found augmentation with calcium phosphate bone cement significantly decreased the incidence of intra-articular screw penetration following treatment of proximal humerus fractures with locked plates. Based upon these findings, we recommend its use in this clinical application.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.