Bone graft augmentation reduces complications in osteosynthesis of proximal humerus fractures: A meta-analysis of randomized controlled trials.

Abstract

Objective With the increasing incidence of operatively treated proximal humerus fractures (PHF) and the high prevalence of osteoporosis, it is becoming harder to obtain a stable reduction until the fracture heals. Osteosynthesis augmentation with bone graft (BG) is a proposed solution to this issue. Methods PubMed, Cochrane, and Google Scholar were screened up until December 2025. A sub-analysis by type of graft (biologic [Fibular allograft, femoral head allograft, iliac crest autograft] or synthetic) was performed. Results Five randomized controlled trials (RCTs) met the inclusion criteria with 175 patients in the graft-group and 175 in the control-group, and a mean follow-up of 1.6 years. The graft-group had a lower rate of complications when BG was used (odds-ratio = 0.21; p = .001) even when sub-analyzing by type of BG. The graft group had a shorter healing time (mean difference = -3.25 weeks; p = .02) and less pain (mean difference = -0.99; p = .03) when a biologic graft was used with no difference between the graft-group and control-group in healing time or pain when synthetic graft was used. Conclusion Patients undergoing PHF osteosynthesis with BG had a lower rate of complications. A shorter healing time and less pain was also observed in patients receiving biologic BG with their PHF osteosynthesis. Level of evidence.