Fibular Strut Allograft Medial Calcar Substitution in Atrophic Proximal Humerus Surgical Neck Nonunion in the Elderly

To report the technique and describe the outcomes of the use of a medial support fibular strut construct for treating varus humeral surgical neck nonunions in older patients.

Older patients (≥ 60 years) who presented with a surgical neck varus nonunion initially treated with or without previous surgery were identified. All patients underwent repair with nonunion takedown, anatomic alignment with a plate and screw construct, and medial cortical substitution with an allograft fibular strut and autogenous iliac crest graft. Patients were followed prospectively. Patient demographics, injury and surgery characteristics, radiographic and clinical healing, in-hospital and post-operative complications, and follow-up range of motion were systematically collected and analyzed.

Six patients, mean age 70.5 ± 8.7, who presented with an atrophic humeral surgical neck nonunion with medial calcar deficiency were identified. All six patients (100%) achieved union with an average healing time of 4.5 months. One patient required an early revision due to hardware failure 3 weeks following revision surgery. At the 12-month follow-up, forward elevation of the shoulder averaged 138° ± 33°. Significant functional improvement was observed, with average preoperative SMFA scores of 42.0 ± 11.1 improving to 11.1 ± 12.1 12 months post-operatively.

The use of a fibular strut construct as a solution for humeral surgical neck nonunion with medial calcar loss demonstrates an alternative treatment for a complex type of proximal humerus nonunion in older populations. Patients who healed experienced high rates of functional recovery, underscoring its effectiveness as a treatment modality.