title: Fibular Strut Graft Augmentation for Open Reduction and Internal Fixation of Proximal Humerus Fractures: A Systematic Review and the Authors' Preferred Surgical Technique.
abstract: BACKGROUND
  Proximal humerus fractures are common problems plaguing the elderly population.
  
  
  OBJECTIVE
  The purposes of this study were to determine the outcomes of fibular strut allografts in treatment of proximal humerus fractures with open reduction internal fixation (ORIF) and to present the authors' preferred surgical technique. The hypothesis was that the use of fibular strut allografts in treating proximal humerus fractures with ORIF will provide low reoperation rates with acceptable outcomes.
  
  
  METHODS
  Systematic review; Level of evidence, 4.
  
  
  METHODS
  A systematic review was registered with PROSPERO and performed with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting arthroscopic elbow outcomes with levels of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student t tests, 1-way analysis of variance, chi-square tests, and 2-proportion Z tests.
  
  
  RESULTS
  Four studies met the inclusion criteria. While there is great heterogeneity existing in the literature surrounding use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures, current evidence shows a humeral head screw penetration rate of 3.7% with acceptable functional outcome scores, with a reoperation rate of 4.4% at a weighted mean 80.78 weeks (1.55 years) of postoperative follow-up.
  
  
  CONCLUSIONS
  There is great heterogeneity that exists in the literature surrounding the use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures. Current evidence shows a screw penetration rate of 3.7% with acceptable functional outcome scores, demonstrating fibular strut allograft is a viable option for treating proximal humerus fractures.
authors: Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
authors: Bryan M
authors: BM
authors: Saltzman
authors: Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
authors: Brandon J
authors: BJ
authors: Erickson
authors: Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
authors: Joshua D
authors: JD
authors: Harris
authors: Toledo Orthopaedic Surgeons, Department of Orthopaedics, University of Toledo, Toledo, Ohio, USA.
authors: Anil K
authors: AK
authors: Gupta
authors: Florida Orthopaedic Institute, Tampa, Florida, USA.
authors: Mark
authors: M
authors: Mighell
authors: Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
authors: Anthony A
authors: AA
authors: Romeo
keywords: fibular strut; open reduction internal fixation; proximal humerus fracture; shoulder; surgical