Allogenic bone grafting for augmentation in two-part proximal humeral fracture fixation in a high-risk patient population

The surgical fixation of unstable, varus displaced two-part fractures of the proximal humerus remains challenging. In a case series of 10 non-compliant, high-risk patients (median age 63 years; range 52-78), a cancellous allograft was used to augment plate fixation of the fractures. After a median follow-up of 28.5 months, all but one fracture were healed, with the bony allografts incorporated without any systemic or local complications. No significant loss of reduction or evidence of avascular necrosis of the humeral head was seen. The median Constant-Murley Score was 72.0 (range 45-86). Median pain on a visual analog scale was 1 (range 0-7). Median values for the range of motion were flexion: 155A degrees (range 90-170), abduction: 168A degrees (range 95-180) and external rotation: 43A degrees (range: 30-50). Compared to the uninjured contralateral side, flexion was impaired by 13 %, abduction by 14 %, and external rotation by 15 %. Median abduction power was 64 % of the uninjured side. The median varus displacement was 51A degrees (range 45-59) preoperatively, 4A degrees (range -5 to 19) intraoperatively, and 13A degrees (range 1-18) at the time of the final follow-up, relating to an improvement of 38A degrees compared to the preoperative status. The augmentation of proximal humeral fracture fixation using a cancellous allograft might be a viable and reliable alternative to prevent early varus failure and to, moreover, lead to bony union in a non-compliant or high-risk patient population.