Effect of Fibular Allograft Augmentation in Medial Column Comminuted Proximal Humeral Fractures

Abstract

Background:Previous observational studies and meta-analyses have recommended augmentation with a fibular allograft (FA) during the treatment of proximal humeral fractures with locking plates (LPs). However, to our knowledge, randomized controlled trials comparing open reduction and internal fixation (ORIF) with and without FA have not been performed to date.Methods:This was a randomized controlled trial in which adults with a medial column comminuted proximal humeral fracture were randomly allocated to undergo ORIF with an LP (the LP group) or with an LP augmented with an FA (the FA group). Patients were followed for 24 months. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months after the surgical procedure. The secondary outcomes included the DASH score at other time points, shoulder function, pain score, satisfaction, complications, and changes in neck-shaft angle and humeral head height.Results:From October 20, 2016, to December 24, 2019, 80 patients were randomized. There were 52 women (65%), and the mean patient age (and standard deviation) was 65 ± 14 years. Of the 80 patients, 39 were allocated to the FA group and 41 were allocated to the LP group. At the primary time point (12 months), the unadjusted mean between-group difference in DASH score was −1.2 (95% confidence interval [CI], −7.3 to 5.0; p = 0.71) favoring the FA group, and, with adjustment for smoking, alcohol drinking, and diabetes, the between-group difference was −1.4 (95% CI, −7.7 to 5.0; p = 0.67) favoring FA. No significant differences between the 2 groups were found among the secondary outcomes.Conclusions:No additional benefit was found for FA augmentation in treating medial column comminuted proximal humeral fractures.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Application of Intramedullary Calcar Support Plate and Lateral Locking Plate in Elderly Patients with Neer 3 and 4-Part Fractures of Proximal Humerus Through a Deltoid Splitting Approach

“…From a biomechanical perspective, the intramedullary calcar support plate, allograft, and lateral locking plate were used together to stabilize and support the proximal humeral fractures effectively. Some studies have used large autogenous/allogeneic fibular grafts to treat complex proximal humeral fractures [ 32 , 42 , 43 ], reducing postoperative reduction loss and increasing the fracture union rate compared to the control group. Our results are consistent with these studies.…”

Fibula allograft in complex three-part and four-part proximal humeral fractures in active patients, a matched case-control study

“…A recent randomized controlled study showed that using a fibula allograft did not result in better outcomes or less complications. 34 However, this study only included patients with medial comminuted fractures in elderly patients and also included fracture type Neer 2. Moreover, the study compared heterogeneous groups (fibular allograft vs. locking plates) whereas our study matched cases one on one.…”

“…Moreover, the study compared heterogeneous groups (fibular allograft vs. locking plates) whereas our study matched cases one on one. 34 We specifically included patients with anatomical neck fractures which are more likely to collapse. This might exactly be the reason why we found better outcomes in the fibula group.…”

What’s New in Orthopaedic Trauma

“…The lack of restoration of the medial column has been suggested to contribute to fixation failure. An RCT compared clinical and radiographic outcomes following locking plate fixation with (39 patients) or without (41 patients) a fibular allograft for proximal humeral fractures with medial column comminution 2 . There was no clinically important improvement in the Disabilities of the Arm, Shoulder and Hand (DASH) score or improvement in postoperative radiographs with addition of fibular allograft augmentation at 1 year.…”