Surgical treatment of proximal humerus fractures with using the original allogeneic fibula graft: retrospective cohort study

Abstract

BACKGROUND: A proximal humerus fracture (PHF) is quite common and accounts for approximately 5% of all fractures. During surgery, these fractures make it difficult to correctly reattach the bone fragments. Various special techniques are needed for repositioning and stable fixation of the fragments. When considering the most effective ways to facilitate fracture repositioning and prevent secondary displacement, we paid attention to the publications on the use of the fibula graft.
 AIM: To evaluate the effectiveness of a new allogeneic bone-collagen graft from the fibula head in PHF osteosynthesis with a plate having angular stability in conditions of bone tissue deficit.
 MATERIALS AND METHODS: An original bone-collagen allogeneic graft from the proximal part of the fibula was developed. We carried out a comparative analysis of the treatment results in patients operated on using the fibula head allograft (group O 48 patients, subgroup O1 - 35 patients; period - not less than 1 year after surgery) and the group without using augmentation graft (group K 32 patients). The results were assessed using clinical, radiological, and standardized Constant Shoulder Score; the statistical analysis was also performed.
 RESULTS: No patient in group O developed secondary dislocation, while in group K it was noted in 5 (16%) patients. Head collapse developed in 3 patients (7%) in group O and 8 (25%) in group K. Surgery time was shorter in group O than in group K. The mean Constant Scholder Score in subgroup O1 was 78 and in group K 70. Thinning in the cortical layer of the graft and the border disappearance between the spongy part of the graft and the bone tissue of the humeral head were noted in all patients during multispiral CT scanning over time, which was considered a sign of graft remodeling and lysis.
 CONCLUSION: In severe PHF with bone deficit, it is possible to perform organ preseration surgery regardless of the patients age and obtain functional results satisfying both the patient and the physician. Our suggested method of severe PHF surgical treatment combined with bone deficit facilitates repositioning, reduces operation time, and decreases the number of complications.