Improved Outcomes Using a Fibular Strut in Proximal Humerus
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Proximal humerus fractures, although common, have high rates of failure after open reduction and internal fixation. The use of a fibular allograft has been explored as a means to decrease complications, particularly varus collapse and the need for revision surgery. The authors performed a retrospective review of 133 proximal humerus fractures managed surgically with locking plates or locking plates with fibular allograft intramedullary struts. Demographic, intraoperative, and postoperative variables were collected and analyzed. The fibular allograft group was more likely to be older, be female, and have a history of osteoporosis.

No differences were noted in the proportions of 2-, 3-, or 4-part fractures between groups. The average follow-up was 28 weeks. Medial calcar length was longer in the locking plate only group; however, this group demonstrated a decreased head shaft angle and a trend toward increased rates of varus collapse . No significant differences were found regarding other radiographic complications, irrespective of fracture complexity. A notable decrease in fluoroscopy time was seen with strut use, but operative time and blood loss were similar between groups. A significant decrease in revision surgery rate was found with use of an allograft strut. Using a strut appears to preserve the radiographic head shaft angle and decrease the risk of fracture collapse in 2-, 3-, and 4-part fractures, without increasing surgical time or morbidity. Use of an intramedullary strut appears to reduce the need for revision surgery, particularly in 3- and 4-part fractures.