No additional benefit of fibular allograft augmentation in treating proximal humeral fractures

Previous observational studies and meta-analyses have recommended augmentation with a fibular allograft (FA) during the treatment of proximal humeral fractures with locking plates (LPs). However, randomized controlled trials comparing open reduction and internal fixation (ORIF) with and without FA have not been performed.

This was a randomized controlled trial conducted by Qiuke Wang et al. the trail was conducted at Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China. The study has been published in “THE JOURNAL OF BONE AND JOINT SURGERY”. They found that there was no additional benefit for FA augmentation in treating medial column comminuted proximal humeral fractures.

Patients with a medial column comminuted proximal humeral fracture were randomly allocated to undergo ORIF with an LP (the LP group) or with an LP augmented with an FA (the FA group). Patients were followed for 24 months. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months after the surgical procedure. The secondary outcomes included the DASH score at other time points, shoulder function, pain score, satisfaction, complications, and changes in neck-shaft angle and humeral head height.

Key findings of the study:

• 80 patients were randomized in the study period.

• There were 52 women (65%), and the mean patient age (and standard deviation) was 65 ± 14 years.

• Of the 80 patients, 39 were allocated to the FA group and 41 were allocated to the LP group.

• At the primary time point (12 months), the unadjusted mean between-group difference in DASH score was 21.2 (95% confidence interval [CI], 27.3 to 5.0; p = 0.71) favoring the FA group, and, with adjustment for smoking, alcohol drinking, and diabetes, the between-group difference was 21.4 (95% CI, 27.7 to 5.0; p = 0.67) favoring FA.

• No significant differences between the 2 groups were found among the secondary outcomes.

The authors commented – “In conclusion, among adults with medial column comminuted proximal humeral fractures, FA augmentation provided no additional benefit, in either clinical or radiographic outcomes, compared with using an LP alone, within 1 year after ORIF. Similar results were found at 24 months, but were limited by the considerable loss to follow-up.”

Level of Evidence: Therapeutic Level II.

Further reading:

Effect of Fibular Allograft Augmentation in Medial Column Comminuted Proximal Humeral Fractures A Randomized Controlled Trial

Qiuke Wang, Ning Sheng et al

THE JOURNAL OF BONE AND JOINT SURGERY 2023;105:302-11

http://dx.doi.org/10.2106/JBJS.22.00746