Varus impacted proximal humeral fractures (B2.2) is a unique type of fracture with multiple sequelae and unpredictable outcome. There is a high incidence of varus collapse and loss of fixation associated with this type of fracture especially in patients with loss of medial calcar. This created the idea of reconstructing the medial calcar during internal fixation to avoid recurring deformity and malunion. The aim of this study was to evaluate the results of fixation of varus impacted proximal humeral fracture using locking plate fixation with a calcar screw and without the use of bone grafting or opening of the joint capsule for reconstruction of the medial buttress.
A series of 39 operative procedures of varus proximal humeral fractures were fixed with locking plate and calcar screws. Clinical and radiographic outcomes were collected and evaluated.
At 2-year follow-up, the mean Constant score was 83.9±6.4 (range 68-92), with four patients lost for different reasons. At final follow-up, the head-shaft angle was 130.3±8 degrees (range 111-143 degrees), the change in the angle because of subsidence ranged between 0 to 20 degrees (4.4±5.3 degrees). The complications included two superficial wound infections, one developed greater tuberosity nonunion, and nine had subsidence of the head with minor change of the head-shaft angle at follow-up. Six patients had a change of 5 to 10 degrees, while three patients had a 10 to 20-degree change.
Medial calcar comminution can be treated successfully by the use of locking plate fixation with calcar screws with no additional grafting. Long-term follow-up is required to ensure the persistence of good results.