Improved Outcomes Using a Fibular Strut in Proximal Humerus Fracture Fixation

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomaterials in Orthopedics

Background:

• Proximal humerus fractures are common and have high failure rates with standard fixation.
• Varus collapse and revision surgery are significant complications after open reduction and internal fixation.

Purpose of the Study:

• To evaluate the efficacy of fibular allograft intramedullary struts in reducing complications for proximal humerus fractures.
• To compare outcomes of locking plates with and without fibular allograft struts.

Main Methods:

• Retrospective review of 133 proximal humerus fractures.
• Comparison between locking plates alone (n=72) and locking plates with fibular allograft struts (n=61).
• Analysis of demographic, intraoperative, and postoperative variables, including radiographic outcomes and revision rates.

Main Results:

• The fibular allograft group had higher rates of older age, female sex, and osteoporosis.
• No difference in fracture complexity (2-, 3-, or 4-part).
• Fibular allograft struts showed a trend toward decreased varus collapse (P=.06), preserved head shaft angle (P=.01), reduced fluoroscopy time (P=.04), and significantly lower revision surgery rates (P=.05).

Conclusions:

• Fibular allograft intramedullary struts appear to preserve radiographic alignment and decrease fracture collapse in proximal humerus fractures.
• Strut use reduces the need for revision surgery, especially in complex 3- and 4-part fractures, without increasing operative time or morbidity.