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Bone grafting augmentation choices in complex proximal humerus fractures: A systematic review
Ali Etemad-Rezaie1, Serena Dienes2, Chetan Gohal3
1Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
Journal of Orthopaedics
|October 10, 2024
Summary
Bone graft augmentation aids complex proximal humerus fracture repair. While fibular strut allografts are common, no single graft type shows superiority, with similar union rates and functional scores across types.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Regenerative Medicine
Background:
- Complex proximal humerus fractures often require surgical intervention.
- Bone graft augmentation is utilized to enhance fixation stability and promote healing.
- Evaluating the efficacy of various bone graft techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To systematically identify and evaluate different bone graft augmentation techniques in the operative treatment of complex proximal humerus fractures.
- To compare the outcomes, including union rates and functional scores, associated with various bone graft types.
Main Methods:
- A comprehensive literature search was conducted across four databases (1970-February 2023) for studies on bone augments in proximal humerus fracture fixation.
- Study quality was assessed using standardized tools (JBI, MIoNS, Cochrane Risk of Bias).
- Descriptive statistics, including weighted means, were used to analyze data from 33 included articles (964 patients).
Main Results:
- Seven bone augments were identified, with fibular strut allograft being the most common (693 patients).
- Fracture union rates were high and similar across groups (average 99.6%).
- Average Constant Murley Scores (CMS) ranged from 76.8 to 81.8, with no significant differences noted between most graft types.
Conclusions:
- Bone graft augmentation is an effective adjunct for open reduction internal fixation of complex proximal humerus fractures.
- Fibular strut allograft is the most frequently used bone graft augment.
- While bone graft augmentation generally leads to good outcomes, no single graft type demonstrates clear superiority; further comparative studies are warranted.
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