Role of Fibular Allograft in Proximal Humerus Fractures: A Systematic Review

Objectives: To analyze the outcomes and complication rates of fibular allografts (FA) as an augmentation technique for proximal humeral fractures and determine their appropriate indications. Data Sources: English- and Spanish-language articles in PubMed, MEDLINE, Embase, Web of Science (Core Collection), and Google Scholar databases were systematically reviewed with the Preferred Reporting Items for Systematic Reviews guidelines on April 10, 2020. Study Selection: Studies of patients with proximal humeral fractures treated primarily with FA and locking compression plates and with a minimum follow-up of 6 months were included, and presenting results with standardized clinical scales, radiological values, and operative complications. Data Extraction: Two authors independently extracted data from the selected studies with a standardized data collection form. Subsequently, each extracted data set was consolidated on the agreement of authors. Data Synthesis: From the initial screening of 361 articles, 5 case series and 6 retrospective cohort studies were included. A meta-analysis was not performed. Conclusions: FA improved the clinical and radiological results, thereby reducing complications. The optimal indication for this procedure may be a 4-part fracture with medial column disruption in younger adults.

Automated summary

This study analyzed the outcomes and complication rates of fibular allografts as an augmentation technique for proximal humeral fractures and provided recommendations for their appropriate indications. The results showed that fibular allografts improved clinical and radiological outcomes and reduced complications. It may be most suitable for patients with 4-part fractures and medial column disruption, especially in younger adults.