Operative Treatment with Intramedullary Fibular Strut Allograft for Osteoporotic Proximal Humerus Fracture

Abstract

Background: The purpose of this study was to investigate the clinical and radiological outcomes of locking plate fixation with fibular strut allograft to manage unstable osteoporotic proximal humerus fractures. Methods: We retrospectively reviewed 15 patients who underwent open reduction and locking plate fixation with fibular strut allograft for osteoporotic proximal humerus fracture between July 2011 and June 2015. For functional evaluation, we evaluated visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion. For radiological evaluation, shoulder true anteroposterior (AP) and AP in 20° external rotation, as well as the axillary view were taken at two weeks, six weeks, three months, six months, and one year. And the neck-shaft angle was measured on the AP view in 20° external rotation view. Results: At the one-year follow-up, mean VAS pain score and all shoulder scores, including ASES score and UCLA shoulder score, exhibited satisfactory clinical outcomes. All patients obtained bone union between three and six months post-procedure. Moreover, the mean immediate postoperative neck-shaft angle was 138° ± 4°, and at one-year follow-up, the neck shaft angle was 137° ± 5°. There was no significant difference between the preoperative and postoperative values (p=0.105). Conclusions: For the unstable two-part and three-part osteoporotic proximal humerus fractures with medial calcar comminution, the use of fibular strut allograft with locking plate fixation was effective in maintaining the initial status of reduction and exhibiting the satisfactory functional and radiological outcomes.

The biomechanical effect of fibular strut grafts on humeral surgical neck fractures with lateral wall comminution

“…Considering that proximal humeral fractures occur in the elderly, stability of fixation may be significantly compromised by lack of lateral wall integrity of the greater tuberosity, especially in cases of low bone mass in the humeral head 4 . Although it is well known that fibular strut grafts have enhanced the results of locking plate fixation in unstable osteoporotic proximal humerus fractures with medial wall comminution 8 , 14 , no studies have evaluated the effect of fibular strut augmentation on the stability of locking plate fixation for osteoporotic proximal humeral fractures with lateral wall comminution.…”

Total Hip Arthroplasty in the Severely Narrowed Femoral Canal by a Fibular Strut Using Knee Arthroscopic Tools: A Case Report and Technical Note

“…Obstruction of any kind should be addressed for proper preparation and positioning of the component. Use of a fibula strut as a “biological intramedullary nail” has been reported for nonunion of long bone fractures, either as standalone fixation or as an adjunct in osteoporotic fractures 3 4 5) . In addition, use of segments of fibula in osteonecrosis in an attempt to salvage the femoral head is not uncommon.…”