Bone Grafting Augmentation Choices in Complex Proximal Humerus Fractures: A Systematic Review

Overview

Journal J Orthop

Specialty Orthopedics

Date 2024 Oct 10

PMID 39386069

Authors

Ali Etemad-Rezaie

Serena Dienes

Chetan Gohal

Valerie Politis-Barber

Stephanie Searle

Diane Nam

Ujash Sheth

Affiliations

Soon will be listed here.

Abstract

Objective: To systematically identify and evaluate different bone graft augmentation techniques in the operative treatment of complex proximal humerus fractures.

Methods: Thirty-three articles including 964 patients met the inclusion. Seven bone augments were identified, including fibular strut allograft (693 patients across 21 studies), femoral head allograft (84 patients across 4 studies), iliac crest allograft (54 patients across 3 studies), iliac crest autograft (94 patients across 5 studies), humeral endosteal allograft (6 patients in 1 single study), unspecified cancellous allograft (28 patients in 1 single study) and distal clavicle autograft (3 patients in 1 single study). Mean patient age was 67.1 years, with female patients comprising 65.2 %. Fracture union rates were similar between groups, with an average of 99.6 %. The average Constant Murley Score (CMS) was not reported in the humeral endosteal allograft or the distal clavicle autograft group but was 81.8 (fibular strut allograft), 79.1 (femoral head allograft), 76.8 (iliac crest allograft), 77.7 (iliac crest autograft), and 81.5 (unspecified cancellous allograft) in the remaining groups. Revision surgery was required in 16.7 % of patients receiving humeral endosteal allograft, 7 % of patients with femoral head allograft, 2 % of iliac crest autografts and 1.9 % in the fibular allograft group. Reported complications included avascular necrosis, hardware complications and loss of reduction.

Conclusion: Bone graft augmentation is an effective adjunct to open reduction internal fixation of complex proximal humerus fractures. Fibular strut allograft is the most common bone graft augment used. Majority of patients treated with bone graft augmentation achieved bony union (83%-100 %) and average CMS scores at final follow-up were similar between graft types (76-82). However, no conclusive data suggests superiority of one bone graft type over another. Future studies should aim to compare the outcomes amongst graft types.

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