Restoring the Shattered Shoulder: Fibular Head Strut Allograft as a Salvage for Severe Metaphyseal Comminution in Proximal Humeral Fractures
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Abstract
Treating comminuted proximal humerus fractures (PHF) in elderly patients with severe osteoporosis remains a clinical challenge. While arthroplasty is often the standard choice, it does not always guarantee optimal functional outcomes. Conversely, intramedullary fibular strut allografts enhance reduction stability during locking plate fixation. However, clinical literature on using the fibular strut allograft in this manner is scarce.
We report a novel surgical approach using a fibular strut allograft including the fibular head in a female patient in her 60s with a severely comminuted PHF and osteoporosis. Rather than performing shoulder arthroplasty at the six-month short-term follow-up, we opted for osteosynthesis using this unique graft configuration. At the six-month follow-up, the patient demonstrated bony union and favorable functional recovery without complications or loss of reduction. However, there remain certain limitations concerning confounding variables, including the augmentation with non-absorbable sutures for additional stability and the short follow-up period of only six months.
This case suggests that utilizing a fibular strut with the fibular head provides structural support for severe metaphyseal comminution. This technique offers a promising biological alternative to arthroplasty, potentially preserving the natural joint even in the most challenging osteoporotic fractures.
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