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BioMed Research International
Volume 2015, Article ID 170283, 8 pages
Clinical Study

Medial Calcar Support and Radiographic Outcomes of Plate Fixation for Proximal Humeral Fractures

1Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi City, Taiwan
2College of Medicine, Chang Gung University, Taoyuan City, Taiwan
3Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan City, Taiwan

Received 7 August 2014; Revised 6 January 2015; Accepted 7 January 2015

Academic Editor: Sae H. Kim

Copyright © 2015 Shih-Jie Lin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Plate fixation remains one of the most popular surgical procedures for treating proximal humeral fractures (PHFx); however, substantial rates of complications have been reported in the literature. The objectives of the study were to examine how medial calcar support (MCS) affects the radiographic outcomes and to determine the prognostic factors predicting treatment failure. We performed a retrospective cohort study of 89 adult patients who had PHFx and were treated with plate fixation at our institution in 2007–2011. The enrolled patients were separated into two groups according to disruption of medial calcar. Our results revealed an increased rate of poor radiographic outcomes in patients with disrupted medial calcar. Osteonecrosis of the humeral head and redisplacement were the two radiographic outcomes which had a positive causality with disruption of medial calcar ( and 0.050, resp.). Deficient medial calcar, inadequate reduction, diabetes mellitus, chronic kidney disease, and chronic liver disease were all significant predictors for the development of osteonecrosis in patients after PHFx surgery. Inadequate reduction was also a predictor for redisplacement. We confirmed that the restoration of medial calcar as well as comorbid conditions plays key roles in treatment of patients having PHFx with disrupted medial calcar.