Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

Abstract

BackgroundProximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs.MethodsWe retrospectively reviewed 60 patients (mean age, 72.75 years) with closed 3- or 4-part fractures, and a minimum of 2 years of follow-up. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score.ResultThe average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p < 0.001] and NSA of 9.94° versus 3.12° [p < 0.001]) . The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p = 0.024] and ASES score of 72.80 vs 78.64 [p = 0.022]). The FA group showed better forward elevation (p = 0.010) and abduction (p = 0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p < 0.001).ConclusionFor comminuted PHFs in elderly patients, LCP fixation combined with a fibular allograft is reasonable option to ensure satisfactory radiological and clinical outcomes.Trial registrationZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. Date of registration: 2018-05-17.

Effects of fibular strut augmentation for the open reduction and internal fixation of proximal humeral fractures: a systematic review and meta-analysis

“…No article was judged to be of poor quality. Two articles [ 14 , 15 ] were excluded because other techniques that might be a potential confounding factor to the clinical result were used, thus leaving eight studies that were considered to be suitable for the inclusion in this review [ 9 , 10 , 16 – 21 ] (Fig. 1 ).…”

“…Considering that one patient might have more than one complication and that there would be a strong link between these complications (e.g. a patient might have had varus malunion or humeral head collapse that led to a screw perforation), the complication rate was calculated as the number of patients with complications in each group, which was reported in six studies [ 10 , 16 – 20 ]. Pooling the estimates confirmed a lower likelihood of the complication incidence associated with the application of FSA (OR 0.48; 95% CI 0.25–0.92; I 2 = 7.52%; 95% PI 0.16–1.45) (Fig.…”

“…The measurement scales used in each trial varied, and most studies used more than one scale to assess the postoperative function, including the Constant score/Constant–Murley score (CMS) [ 22 ], American Shoulder and Elbow Surgeons (ASES) score [ 23 ], disability of arm–shoulder–hand (DASH) score [ 24 ], and Simple Shoulder Test (SST) [ 25 ]. After excluding two studies without sufficient data for the analysis [ 9 , 20 ], data syntheses were conducted based on six studies [ 10 , 16 – 19 , 21 ] and showed statistically significant differences in functional recovery in favour of the application of FSA (CMS: MD 5.07; 95% CI 3.40–6.74; I 2 = 0.00%; 95% PI 2.361–7.78; ASES: MD 5.08; 95% CI 3.67–6.49; I 2 = 0.00%; 95% PI 1.98–8.18), without obvious evidence of heterogeneity (Fig. 3 ).…”

Comparison between minimally invasive plate osteosynthesis and the deltopectoral approach with allogenous fibular bone graft in proximal humeral fractures

“…Cha et al [25] reported that, in radiological evaluation in the postoperative follow-up, allogenous bone graft maintained the reduction better. Furthermore, Cui et al [26] also recently reported that in terms of clinical results, the allogenous bone graft group had better outcomes. In this study, however, there was no difference in clinical and radiological results between the patients who underwent Table 2.…”

Use of Osteobiologics for Fracture Management: The When, What, and How

“…In the setting of osteoporotic fractures, it is commonly used with a strut (e.g. fibula strut) that provides mechanical support [37] . The use of cortical strut allografts has been described in periprosthetic fractures of the femur, proximal humerus [38] as well as in the setting of nonunions of the distal femur and humeral shaft [39] .…”