Improved Outcomes Using a Fibular Strut in Proximal Humerus Fracture Fixation

Abstract

Proximal humerus fractures, although common, have high rates of failure after open reduction and internal fixation. The use of a fibular allograft has been explored as a means to decrease complications, particularly varus collapse and the need for revision surgery. The authors performed a retrospective review of 133 proximal humerus fractures managed surgically with locking plates (n=72) or locking plates with fibular allograft intramedullary struts (n=61). Demographic, intraoperative, and postoperative variables were collected and analyzed. The fibular allograft group was more likely to be older ( P <.01), be female ( P =.04), and have a history of osteoporosis ( P =.01). No differences were noted in the proportions of 2-, 3-, or 4-part fractures between groups. Average follow-up was 28 weeks. Medial calcar length was longer in the locking plate only group ( P =.04); however, this group demonstrated a decreased head shaft angle ( P =.01) and a trend toward increased rates of varus collapse ( P =.06). No significant differences were found regarding other radiographic complications, irrespective of fracture complexity. A notable decrease in fluoroscopy time was seen with strut use ( P =.04), but operative time and blood loss were similar between groups. A significant decrease in revision surgery rate was found with use of an allograft strut ( P =.05). Using a strut appears to preserve the radiographic head shaft angle and decrease the risk of fracture collapse in 2-, 3-, and 4-part fractures, without increasing surgical time or morbidity. Use of an intramedullary strut appears to reduce the need for revision surgery, particularly in 3- and 4-part fractures. [ Orthopedics . 2020;43(5):262–268.]

Comparison between open reduction and internal fixation and minimally invasive plate osteosynthesis for unstable proximal humerus fractures treated with locking plate and intramedullary allograft: a retrospective study

“…This additional rather elastic stabilization meets Lill's criteria for setting of an ideal xation device for PHFs [46]. Overall, the available clinical studies demonstrate good or excellent functional results with a small percentage of complication when using IMG with LP for unstable PHFs [23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

“…From the available literature, most authors use ORIF when using LP and IMG xation for unstable PHFs [23][24][25][26][27][28][29][31][32][33][34][35][36] and only one author uses MIPO technique with the deltoid splitting approach [30]. approaches came to a similar conclusion [43].…”

“…In a pilot study, Gardner et al [17] enhanced the stability of LP constructs by adding intramedullary bular allograft in seven cases of unstable PHFs with medial calcar de ciency and/or osteoporosis, demonstrating no complications. Their promising results have leveraged the interest towards biomechanical [18][19][20][21][22] and clinical studies [23][24][25][26][27][28][29][30][31][32][33][34][35][36] focusing on the treatment of unstable PHFs with simultaneous application of locked plating and intramedullary grafting. While most of these authors use open reduction and internal xation (ORIF), there is still a lack of reports focusing on xation of unstable PHFs with LP and IMG using the minimally invasive plate osteosynthesis (MIPO) technique.…”

The Corkscrew Technique for Removing a Fibular Strut Allograft From the Proximal Humerus

“…Fibular strut endosteal augmentation has been described in studies to provide additional support and decrease implant failure rates in displaced fractures with varus coronal malalignment that have significant metaphyseal bone loss with or without medial calcar comminution [ 11 , 12 ]. Use of fibular strut augmentation with lateral locking plates has shown to aid in preventing varus collapse, decrease rate of screw cut-out, improve healing rates, reduce avascular necrosis of the humeral head and maintain overall stability of the lateral locking plate leading to improved functional and radiographic outcomes [ 11 - 17 ]. Although the rates of complication and failure are relatively low, revision after fibular strut augmentation poses a unique and technically challenging problem.…”

“…One strategy being implemented to decrease complication rates with lateral locking plate is adding a fibular strut allograft to provide endosteal augmentation. Studies have shown adding a fibular strut does improve outcomes and decreases complication rates [ 11 - 17 ]. However, when a fibular strut fails, this leaves the patient with limited options and poses the surgeon with a difficult decision.…”