Borja Segarra, MD, Marta Molina, MD, and Luis Aguilella, MD, PhD
Locking compression plates (LCP) have been widely used in the primary treatment of proximal humeral fractures (PHF), providing a rigid and stable construct.1,2 However, because this type of fracture is more prevalent in patients with poor bone quality3 and bone support, primary repair with LCP may fail because of fracture comminution,4 leading to complications such as screw cutout, loss of reduction, and high reoperation rates.5 To provide greater stability to osteosynthesis, various alternatives have been suggested, such as the addition of a structured bone graft6 or cement to screws.7 Gardner et al proposed the use of fibular allografts (FA) as a structural augmentation method.8 The technique consists of intramedullary placement of a 5- to 6-cm diaphyseal fragment of the fibula, facilitating the reduction and support of the humeral head. The allograft is incorporated into osteosynthesis by LCP, thus strengthening its fixation. The initial clinical outcomes of this technique were satisfactory9 and were maintained in subsequent studies conducted at the same institution.10–15 Although there are some systematic reviews on this technique,16,17 none of them have been conducted with rigorous inclusion criteria. In addition, new comparative studies of fibular augmentation with other techniques18,19 have been published in recent years. In light of these observations, there is an urgent need for a new systematic review of this topic.
Given the increasing popularity of this treatment in recent years, we have performed a systematic review of the literature on the use of FA as an augmentation technique for osteosynthesis of PHF. The purpose of this study was to review the applicable indications for FA and to determine whether its clinical outcomes and complications justify the use of this technique for PHF.