Allograft augmentation in proximal humerus fractures.

Area of Science:

• Orthopedic surgery
• Traumatology
• Bone regeneration

Background:

• Unstable proximal humerus fractures (PHF) present challenges in achieving stable fixation, especially in osteoporotic bone.
• Secondary displacement and limited range of motion (ROM) are common complications.
• High-risk patients with comorbidities require specialized treatment approaches.

Observation:

• A surgical technique involving allografting and plate fixation was applied to (secondarily) displaced PHF with unstable medial hinges and bony deficiency.
• Indications included weak/osteoporotic bone and patient noncompliance.
• Contraindications were open/contaminated fractures and immunodeficiency.

Findings:

• Bony union and allograft incorporation were achieved in 9 of 10 high-risk patients (median age 63 years) after a mean follow-up of 28.5 months.
• The median Constant-Murley Score was 72.0.
• Functional deficits included 13-15% impairment in flexion, abduction, and external rotation, with a mean 38° correction of varus displacement.

Implications:

• This surgical approach offers a viable solution for complex proximal humerus fractures in challenging patient populations.
• It facilitates stable fixation, promoting bone healing and potentially improving functional outcomes.
• Further research may explore long-term functional recovery and optimal patient selection criteria.