Article Details

Proximal humerus fractures account for a significant proportion of upper-extremity injuries and can pose challenges in achieving stable fixation, particularly when the medial calcar is comminuted. Locking-plate fixation alone may not provide adequate medial support, predisposing to varus collapse and fixation failure. Augmentation with a fibular strut graft has been proposed to enhance construct stability and improve functional outcomes.

We report a case of a 23-year-old male sustained a Neer three-part proximal humerus fracture following a road-traffic accident. Open reduction and internal fixation were performed using a PHILOS plate augmented with a non-vascularized intramedullary fibular strut autograft harvested from the ipsilateral leg. Post-operative rehabilitation included early pendulum exercises and progressive range-of-motion therapy. Radiographic union was achieved by 12 weeks. At the six-month follow-up, the patient achieved a Constant-Murley Score of 92/100, indicating excellent functional recovery. Active forward flexion reached 175^°, abduction 170^°, and external rotation was symmetrical to the contralateral side, with no donor-site morbidity. This case highlights the mechanical and biological advantages of fibular strut augmentation in providing medial column support, maintaining reduction, and promoting early rehabilitation. Review of similar reports and comparative studies in the literature supports the use of fibular autograft or allograft in complex proximal humeral fractures, particularly when medial comminution is present. Careful surgical technique and appropriate patient selection can minimize complications and optimize outcomes.

Keywords: Proximal humerus fracture; PHILOS plate; Fibular strut graft; Medial column support; Locking plate fixation