Cancellous bone allograft is comparable to fibular strut allograft for augmentation in three- or four-part proximal humeral fractures.

Abstract: Introduction Bone grafts have been used for augmentation and to improve stability of reduced fractures in proximal humeral fractures. The aim of this study was to analyze the clinical and radiological outcomes following use of cancellous bone (CA) allografts for augmentation in three- or four-part proximal humeral fractures, and compare with fibular strut allografts (FA). Patients and Methods Between November 2016 and February 2018, 55 patients, followed for at least 1 year, with three- or four-part proximal humeral fractures fixed with locking plates were included and grouped according to the type of allograft bone used for augmentation. In this retrospective analysis, we assessed and compared the clinical and radiological outcomes of the two groups, using the visual analogue scale (VAS) score, the Constant–Murley score (CMS), the disability of the arm, shoulder and hand (DASH) score, the range of movement (ROM), neck-shaft angle (NSA), humeral head height (HHH) and the changes of NSA and HHH, as well as recording any complications. The repeatedly-measured clinical and radiological outcomes were analyzed by linear mixed models. The differences in outcomes between groups at the final follow-up were compared by Student’s t test. Results There were 28 patients in the CA group and 27 patients in the FA group with an average follow-up of 14.5 months. The mean age of all patients was 64 (36 to 86). Non-significant group effects were observed on CMS (β = -8.792, P = 0.216), DASH (β = 1.329, P = 0.094), NSA (β = 1.432, P = 0.752) and HHH (β = 1.660, P = 0.628). At the final follow-up, the patients in the CA group showed no significant differences in VAS (1.8 vs 2.2, P = 0.276), CMS (81.5 vs 75.4, P = 0.072), and DASH (11.0 vs 13.5, P = 0.235) scores compared to the FA group. There were no significant differences in the change of NSA (6 vs 4, P = 0.387) or HHH (1 vs 2, P = 0.261). Conclusions Patients with three- or four-part proximal humeral fractures treated with locking plates combined with cancellous bone allografts have good clinical and radiographic outcomes, moreover similar to those treated with fibular strut allografts. Level of evidence Level III; Retrospective Cohort Comparison; Treatment Study