Modified Use of a Fibular Strut in the Reduction and Stabilization of 2-Part Osteoporotic Proximal Humerus Fractures

Purpose: This study introduces a modified use of a fibular strut allograft as an adjunct to lateral locked plating in the treatment of osteoporotic two-part fractures of the proximal humerus. Methods: A prospective series of 13 consecutive patients (mean age 68; range, 60 to 88) with displaced two-part fractures of the proximal humerus were included. The main outcome measures included radiographic healing, clinical and radiographic findings of complications, assessment of shoulder function measured with the Shoulder Function Index, and ultrasonography assessment of rotator cuff disruption. Results: At postoperative month four, every fracture healed as evidenced on radiographic assessment. Clinically, patients achieved an average shoulder forward flexion of 141.5 degrees, external rotation of 37 degrees, and abduction of 98 degrees. The mean Shoulder Function Index score was 73.2 (range, 64 to 77). No patients were included who required a major or a minor revision surgery. The average follow-up was 13.2 months (range, 12 to 15). Ultrasonography demonstrated no tears of the rotator cuff. Discussion: Ina series of 13 patients, our technique facilitated fracture reduction while avoiding additional soft-tissue dissection at the fracture site and enabled supplementary stabilization after application of a lateral locking plate. Using this technique, we had minimal complications, a high rate of osseous healing, and achieved favorable clinical outcomes in a challenging patient population.