Role of Fibular Allograft in Proximal Humerus Fractures: A Systematic Review

Segarra, Borja; Molina, Marta; Aguilella, L.

doi:10.1097/bot.0000000000002404

Cited by 4 publications

(3 citation statements)

References 45 publications

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Section: Tips To Optimize Resultsmentioning

confidence: 99%

“…In a recent systematic review examining the role of fibular allograft in proximal humerus fractures, 11 studies were analyzed, and the authors concluded that fibular allografts reduced complications and improved radiological and clinical results. 35 It is the authors' preferred treatment to use fibular strut allografts in fractures with loss of medical column support and in patients with poor bone quality. Poor bone quality can be defined by the deltoid tuberosity index or the ratio between the outer and inner cortical diameter immediately above the upper end of the deltoid tuberosity.…”

Section: Supplemental Fixation Methodsmentioning

confidence: 99%

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Technical Tips for Reduction and Stable Fixation of Proximal Humerus Fractures

Brodke

Gurbani

Lee

2023

J Am Acad Orthop Surg

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The surgical treatment of proximal humerus fractures, though common, is associated with surprisingly high complication rates upward of 34%. Obtaining a reduction and placing a stable fixation can be challenging because many fractures treated surgically are comminuted and occur in osteoporotic bone. Nevertheless, innovations in technique and implant design are mitigating some failures. These innovations include the use of fibular strut allograft and other fixation adjuncts, the correct placement of calcar screws and other locking fixation, and having a systematic approach to reduction and intraoperative imaging to ensure the restoration of anatomy. This review and accompanying video highlight various technical strategies to maximize the success of surgical treatment for these challenging injuries.

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Section: Tips To Optimize Resultsmentioning

confidence: 99%

Section: Supplemental Fixation Methodsmentioning

confidence: 99%

Technical Tips for Reduction and Stable Fixation of Proximal Humerus Fractures

Brodke

Gurbani

Lee

2023

J Am Acad Orthop Surg

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“…Patients who developed AVN either refused treatment or followed conservative treatment. 20 When the humeral head is necrotic, if the orthopaedic surgeon wants to do a shoulder replacement, reaming of the humerus canal in the presence of an existing intramedullary fibular graft is challenging because the fibula is a dense cortical bone and is typically well-integrated. Lu et al reported good results in the treatment of obsolete proximal humeral fractures with double plates.…”

Section: Advantages Of the Dual Plate Fixation Of The Proximal Humerusmentioning

confidence: 99%

Short‐term Clinical Outcome of Dual Plate Fixation in the Treatment of Proximal Humerus Fractures with Calcar Comminution

Junyang

Cui

et al. 2022

Orthopaedic Surgery

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ObjectiveCalcar comminution has been considered to be the main cause of the failure of internal fixation and fracture nonunion in proximal humerus surgery. Anatomical reduction and increasing the strength of internal fixation is the key to success. The purpose of this study was to investigate the short‐term clinical effect of dual plate fixation in the treatment of proximal humeral fractures with calcar comminution.MethodsThe data of 37 patients with proximal humeral fractures with calcar comminution, treated in our departments from July 2018 to April 2020, were retrospectively analyzed. These patients were treated with anterior plate and lateral PHILOS plate, and followed up for more than 12 months, including 25 cases in Tianjin Hospital and 12 cases in Shanghai General Hospital. The patients included 12 males and 25 females, their age was 54.89 ± 13.59 years (range from 32–79 years), and 21 patients had dominant hand injury. According to the Neer classification, there were 11 two‐part fractures, 22 three‐part fractures, and four four‐part fractures. The range of motion of the shoulder joint, visual analog scale (VAS), American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant–Murley shoulder score, neck‐shaft angle, anterior–posterior angle, and other complication scores were recorded at the last follow‐up.ResultsAll 37 patients were followed up after operation, and the follow‐up time was 21.81 ± 7.35 months (range from 12–36 months). The fractures of all 37 patients had healed at the last follow‐up visit. The neck‐shaft angle measured immediately after operation was 132.59° ± 8.34°, and the neck‐shaft angle measured at the last follow‐up visit was 132.38 ± 8.53°. The anterior–posterior angle measured immediately after surgery was 3.45° ± 0.81°, and the anterior–posterior angle at the last follow‐up visit was 3.66° ± 0.77°. The range of motion of the shoulder joint was as follows: the shoulder joint could be forward elevated by 158.11° ± 13.09° (range: 140°–180°), rotated externally by 38.38° ± 7.55° (range: 20°–45°), and internally rotated to T4‐L4 level. The VAS score was 0.46 ± 0.87 (range: 0–3), the ASES was 86.58 ± 8.79 (range: 56.7–100), and the Constant–Murley score was 88.76 ± 8.25 (range: 60–100). Thirty‐three cases were excellent, and four cases were good. No obvious complications occurred.ConclusionThe combination of anterior plate and lateral PHILOS plate in the treatment of proximal humeral fractures with calcar comminution can achieve stable fixation, and the postoperative clinical and imaging outcome was satisfactory. Firstly, the anterior plate can provide temporary stability when the Kirschner wires are removed, which can provide space for lateral plate placement during fracture reduction and fixation. Secondly, additional support by the anterior plate can provide higher stability in complex fractures with calcar comminution.

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