Managing the Endosteal Fibula During Arthroplasty for Proximal Humeral Fracture Sequelae

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Abstract

Summary:Augmentation of proximal humeral fracture fixation with an endosteal fibular allograft has increased in popularity because it biomechanically improves construct stability and potentially may lead to a lower rate of humeral head collapse. However, the potential need for arthroplasty after proximal humeral fracture fixation may still arise. Placing a humeral stem in the presence of an existing intramedullary fibular graft is challenging because the fibula is dense cortical bone and is typically well-integrated by the time an arthroplasty would be performed. Some have proposed burring the proximal humerus open to receive a stem, or using cannulated intramedullary reamers until a humeral stem can be placed. These steps are tedious and inefficient. We have found the most efficient technique as treating the fibula as if it were a well-fixed humeral stem: freeing it up from the native bone and removing it in its entirety.Video available at:http://links.lww.com/JOT/A802