Technique Spotlight: Endosteal Allograft for Complex Proximal Humerus Fracture Reconstruction

Indications

Proximal humerus fractures are common injuries, and in certain patients, surgical fixation can restore anatomy, provide stability, improve pain, and restore function. Mitigating the risk of postoperative complications is critical for optimizing patient outcomes, and multiple studies have demonstrated reoperation rates of 14%–24%, with preoperative varus deformity in particular having high rates of postoperative failure. Reduction and support of the medial calcar improve maintenance of reduction postoperatively. ^, Restoration of the inferomedial calcar with a customized fibular allograft as an adjunct to a laterally based locking plate ( Fig. 30.1A–C ) is a modern technique which has yielded promising results with reoperation rates as low as 4.4%. The senior author’s relative indications include displaced three- and four-part fractures, osteoporotic bone, varus deformity, or calcar comminution.