The “Sandwich” Technique for the Treatment of Proximal Humerus Fractures

Abstract Proximal humerus fractures (PHFs) are common osteoporotic injuries, often complicated by medial column defects and poor bone quality that lead to fixation failure. Conventional methods using lateral locking plates with fibular grafts provide medial support but are limited by donor-site morbidity, immune rejection, and high costs. To address these challenges, we developed a novel “Sandwich” technique—lateral locking plate–intramedullary reconstruction plate with bone cement (LLP-IRPBC)—aimed at enhancing medial and intramedullary support, improving biomechanical stability, and optimizing fixation outcomes in osteoporotic PHFs. Methods : Five osteoporotic patients (1 male, 4 females; mean age 66.2 ± 8.2 years) with Neer two- to four-part PHFs and medial column defects were treated using the “Sandwich” technique between August 2022 and March 2025. The procedure combined a lateral locking plate, an intramedullary reconstruction plate, bone cement, and cancellous bone grafts to create a three-layer “Sandwich” construct for enhanced support. Postoperative rehabilitation followed a standardized protocol. Functional outcomes were evaluated using the Constant–Murley Score (CMS) and Neer Score at 1, 3, 6, and 12 months. Results : The mean operative time was 123.0 ± 16.1 min, with an average blood loss of 206.0 ± 85.3 mL, hospital stay of 8.4 ± 1.1 days, and mean hospitalization cost of 56,258.4 ± 6,152.1 CNY. At 12 months postoperatively, all fractures achieved radiographic union without loss of reduction, screw penetration, or varus collapse. The mean CMS was 87.0 ± 6.0 and the mean Neer score was 86.0 ± 6.1. No cases of avascular necrosis or fixation failure were observed. Conclusion : The “Sandwich” technique provides strong medial and intramedullary support, improves screw fixation, and enhances overall biomechanical stability in osteoporotic proximal humerus fractures. It achieved excellent healing and functional recovery with minimal complications, representing a promising surgical alternative to traditional fibular graft-assisted fixation.