Disclosures: Myers reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
October 01, 2020
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Fibular struts may decrease risk of varus collapse after humerus fracture fixation

Disclosures: Myers reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Fibular allograft intramedullary struts may decrease risks of complications and fracture collapse after open reduction and internal fixation in patients with proximal humerus fractures, according to published results.

Researchers from OhioHealth Grant Medical Center retrospectively reviewed data on 133 patients who underwent open reduction internal and fixation (ORIF) for two-, three- or four-part proximal humerus fractures with an average follow-up of 28 weeks.

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"Augmentation with the use of a FA compared with the use of a LP alone appears to decrease the risk of varus collapse as represented by the ability to better maintain HSA radiographically."

The cohort was divided into two groups: the locking plate (LP) group, which consisted of patients whose fractures were managed with locking plates alone (n = 72), and the fibular allograft (FA) group, which consisted of patients whose fractures were managed with locking plates with fibular allograft intramedullary struts (n =61). The decision to use a FA was based on surgeon discretion, the researchers noted.

According to the study, outcome measures included change in radiographic head shaft angle (HSA), as well as fracture collapse, complication and revision rates. Initial follow-up was 2 weeks postoperation. Researchers also noted patients in the FA group were more likely to be older, female and have a history of osteoporosis.

At final follow-up, researchers found a smaller change in mean HSA in the FA group (1.8°) than the LP group (4.7°) and a “significantly higher” final mean HSA in the FA group (128°) than the LP group (124°). Additionally, the LP group had a 16% incidence of revision surgery for three- and four-part fractures and an overall revision rate of 9.7% (n = 7), while the FA group had no revisions for three- and four-part fractures and an overall revision rate of 1.7% (n = 1).

The LP group also had a greater than 10° coronal collapse rate of 12.5% (n = 9), while the FA group had a greater than 10° coronal collapse rate of 3.3% (n = 2), according to the study.

“These results are consistent with prior reports, which have detailed high rates of varus collapse following proximal humerus fractures treated with ORIF using only a locking plate,” the researchers wrote in the study. “Augmentation with the use of a FA compared with the use of a LP alone appears to decrease the risk of varus collapse as represented by the ability to better maintain HSA radiographically. The use of FA may also be beneficial in decreasing revision rates in more complex three- and four-part fracture patterns secondary to the additional stability imparted,” they added.