Augmentation in proximal humeral fractures

Abstract

Proximal humeral fractures are common but difficult injuries to treat, particularly in elderly patients with poor bone quality. Operative fixation is associated with variable outcomes and high complication rates. Decreased local bone mineral density, lack of restoration of medial columnar support, nonanatomic reduction, and increased age are predictors of fixation failure. While patient age cannot be controlled, the other predictors can, including local bone mineral density. Therefore, it is critical for clinicians to assess patient bone quality to choose the best treatment method. Augmentation of these fractures can improve biomechanical strength and clinical outcomes. Fibular allografts can increase stability while providing medial columnar support, and injectable bone graft substitutes are readily available and capable of filling patient-specific defects. This review analyzes recent literature evaluating the clinical and biomechanical outcomes of augmentation for proximal humeral fractures and focuses on the indications and surgical techniques for intramedullary fibular strut allografts and injectable bone graft substitutes.