Early Functional Outcomes of Autologous Fibular Strut Graft Augmentation in Open Reduction and Internal Fixation (ORIF) of Proximal Humerus Fractures

TL;DR

Using a fibular strut graft with surgery for shoulder fractures in elderly patients improves early recovery and healing rates.

Contribution

Demonstrates effectiveness of fibular strut graft augmentation in ORIF for proximal humerus fractures.

Findings

Functional scores improved significantly over six months post-surgery.

All patients achieved early radiological union with no major complications.

Near-normal shoulder motion was restored with minimal donor-site issues.

Abstract

Background

Displaced proximal humerus fractures in elderly patients are associated with high rates of fixation failure due to poor bone quality and medial column comminution. Augmentation of locking plate fixation with an intramedullary fibular strut autograft has been proposed to enhance medial support and improve outcomes. This study evaluated early radiological and functional outcomes following open reduction and internal fixation (ORIF) using a proximal humerus internal locking system (PHILOS) plate augmented with a fibular strut autograft.

Objectives

The objectives of this study are to evaluate the early clinical and radiological outcomes of ORIF of displaced proximal humerus fractures using PHILOS plating augmented with an autologous intramedullary fibular strut graft, with emphasis on restoration of medial column support.

Methods

This prospective observational study included 50 patients with closed displaced proximal humerus fractures treated with ORIF using a PHILOS plate and intramedullary fibular strut autograft. Surgery was performed via a deltopectoral approach. Patients were followed at six weeks, three months, and six months postoperatively. Functional outcomes were assessed using the Constant-Murley score and Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiological union, range of motion, and complications were recorded.

Results

The mean Constant-Murley score improved from 60.1 at six weeks to 71.9 at three months and 85.3 at six months (p < 0.05). Mean DASH scores decreased from 32.8 to 19.1 and 12.3 at corresponding intervals (p < 0.05). Early radiological union was achieved in all patients (100%). Shoulder range of motion at final follow-up approached near-normal values. One patient (2%) developed a superficial postoperative infection, which resolved with oral antibiotics. No major early complications were observed. No donor-site morbidity was noted.

Conclusion

Autologous fibular strut graft augmentation during ORIF of displaced proximal humerus fractures is associated with favorable early functional recovery and high early union rates. However, longer follow-up and comparative studies are required to assess long-term complications and durability.

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