Published online Sep 26, 2023. doi: 10.12998/wjcc.v11.i27.6363
Peer-review started: April 9, 2023
First decision: June 15, 2023
Revised: July 18, 2023
Accepted: August 21, 2023
Article in press: August 21, 2023
Published online: September 26, 2023
Processing time: 164 Days and 0.9 Hours
With the intensification of population aging, there are more and more patients with proximal humeral fractures. Elderly fractures are often accompanied by osteoporosis, which can easily lead to the loss of medial support and fixation failure. In recent years, research has shown that fibula resection is one of the methods for treating osteoarthritis in the elderly. Removing the fibula does not affect walking function, and allogeneic fibula material transplantation is a commonly used method to increase the fixation strength of proximal humeral fractures. However, allograft fibula materials are scarce and cannot be used in some areas. Autologous fibula transplantation is reliable and safe.
This study is to observe the therapeutic effect of autologous fibula graft and prove its effectiveness and safety, so as to improve the basis for autologous fibula graft in the treatment of proximal humeral fracture.
The purpose of this study is, on the one hand, to prove that autograft fibula transplantation can increase the fixation strength of humeral fracture, reconstruct the medial support, and obtain better surgical treatment effect; on the other hand, to prove that fibula resection has no impact on walking function, and to prove the safety of fibula bone extraction.
This retrospective, comparative cohort study comprised two groups of patients. Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data. Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation. Group 2 was treated with open reduction and locking plates to enable internal fixation. The intraoperative blood loss volume from the shoulder wound, operative time, shoulder wound pain, bone fracture healing time, Constant-Murley score of the shoulder joint, preoperative Holden walking function score, Mallet score of the shoulder joint, and humeral neck-shaft angle during surgery of the two groups were compared, and the differences were analysed using an independent sample t-test.
The use of autologous fibular bone grafting simplifies surgery, reduces surgical trauma, reconstructs the medial support of the humerus, increases fixation reliability, and achieves better postoperative shoulder joint function without affecting walking function. It is an effective treatment for comminuted proximal humeral fractures in the elderly.
Using locking plates with a fibular autograft may be an effective treatment option for severe proximal humerus comminuted fractures.
Our description of this treatment method may have positive implications for proximal humeral fracture treatment in other regions with situations similar to ours.