The biomechanical effect of fibular strut grafts on humeral surgical neck fractures with lateral wall comminution

No studies have evaluated the effect of fibular strut augmentation on the stability of locking plate fixation for osteoporotic proximal humeral fractures with lateral wall comminution. The purpose of this study was to evaluate the stability of locking plate fixation with a fibular strut graft compared with locking plate alone in an osteoporotic two-part surgical neck fracture model with lateral cortex comminution. Ten paired fresh-frozen cadaveric humeri were randomly allocated into two groups, either the locking plate alone (LP group) or locking plate with fibular strut graft augmentation (LPFSG group), with an equal number of right and left osteoporotic surgical neck fractures with lateral wall comminution of the greater tuberosity. Varus, internal/external torsion, and axial compression stiffness as well as single load to failure were measured in plate-bone constructs, and the LPFSG group showed significantly greater values in all metrics. In conclusion, this biomechanical study shows that fibular strut augmentation significantly enhances varus stiffness, internal torsion stiffness, external torsion stiffness, and maximum failure load of a construct compared to locking plate fixation alone in proximal humeral fractures with lateral wall comminution.