@article{article_1756934, title={Clinical and radiological assessment of iliac crest autograft augmentation in three- and four-part proximal humerus fractures}, journal={Journal of Medicine and Palliative Care}, volume={6}, pages={597–602}, year={2025}, author={Erdogan, Eralp and Güneş, Zafer}, keywords={Proksimal humerus kırığı, Constant-Murley Omuz Sonuç Skoru, İliak krest otogreft, Plak fiksasyonu}, abstract={Aims: To evaluate the clinical and radiological outcomes of locking plate fixation with versus without intramedullary iliac crest cortical autograft augmentation in patients with three- and four-part proximal humerus fractures or fracture-dislocations, particularly in the context of osteoporotic bone and medial calcar insufficiency. Methods: This retrospective study included 65 patients aged between 18 and 65 years treated for complex proximal humerus fractures at a single tertiary institution between 2015 and 2023. Patients were divided into two groups: those treated with locking plate fixation alone (n=47) and those treated with locking plate fixation combined with intramedullary iliac crest autograft augmentation (n=18). Functional outcomes were evaluated using range of motion (ROM), Constant-Murley shoulder outcome score, and Visual Analog Scale (VAS) for pain at 12 months postoperatively. Radiological healing was assessed by time to union. Statistical analyses included t-tests, ANOVA, and Fisher’s exact test, with a p-value <0.05 considered statistically significant. Results: Patients receiving iliac crest grafts (plate+graft group) demonstrated significantly improved union time and greater ROM in flexion, extension, and abduction compared to the Plate-only group (all p <0.001). However, there were no statistically significant differences between the groups in adduction, internal rotation, external rotation, Constant-Murley scores, or VAS pain scores (p>0.05). The mean age of patients was higher in the graft group (49.2 vs. 42.5 years; p <0.001), but this did not alter the functional outcome trends. Conclusion: Iliac crest cortical autograft augmentation in locking plate fixation of complex proximal humerus fractures offers significant biomechanical advantages, including shorter union time and enhanced shoulder mobility in specific planes. Despite these radiological and kinematic benefits, the absence of significant differences in patient-reported outcomes suggests a functional ceiling effect, where improvements in structural stability do not necessarily correlate with perceived clinical benefit. These findings support the selective use of autografts, particularly in fractures with medial calcar deficiency, while also emphasizing the need for individualized rehabilitation protocols and longer-term follow-up to determine the full clinical value of graft augmentation.}, number={5}, publisher={MediHealth Academy Yayıncılık}, organization={Bu çalışma herhangi bir dış destek almamıştır.}