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International Orthopaedics

, Volume 28, Issue 6, pp 333–337 | Cite as

Valgus impacted proximal humeral fractures and their blood supply after transosseous suturing

  • Andreas M. PanagopoulosEmail author
  • P. Dimakopoulos
  • M. Tyllianakis
  • D. Karnabatidis
  • D. Siablis
  • A. X. Papadopoulos
  • E. Lambiris
  • P. Kraniotis
  • G. Sakellaropoulos
Original Paper

Abstract

We treated 16 patients (11 women and five men, average age 45 years), all having four-part valgus impacted fractures of the proximal humerus, with transosseous suturing. All had preoperative angiography performed 6–12 h after admission. The average impaction angle was 43°, and the mean lateral displacement of the humeral head was 1.4 mm. Postoperative angiography was performed 8–10 weeks after the operation followed by digital image processing using the segmentation technique. No statistically important reduction in the length and area of large (>0.5 mm) vessels was seen. Union was confirmed by the reduction in the length and area of small vessels (<0.5 mm). At a mean follow-up of 40 months, avascular necrosis was only found in one patient. The average Constant–Murley score was 87 (67–100) points, whereas the functional score in comparison with the unaffected shoulder was 94% (89–100%). Despite the small number of patients, transosseous fixation seems to preserve the remaining blood supply of the humeral head.

Keywords

Rotator Cuff Humeral Head Lateral Displacement Proximal Humerus Proximal Humeral Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Nous avons traité 16 malades (11 femmes et 5 hommes, d’âge moyen 45 ans), présentant une fracture de l’humérus proximal à 4 fragments, impactée en valgus, avec suture trans-osseuse. Tous avaient une angiographie préopératoire exécutée 6 à 12 heures après l’admission. L’angle moyen de l’impaction était 43° et le déplacement latéral moyen de la tête humérale 1.4 mm. L’angiographie postopératoire a été exécutée 8–10 semaines après l’opération, en utilisant la technique de la segmentation. Aucune réduction statistiquement importante dans la longueur et le territoire des vaisseaux de plus de 0.5 mm n’a été noté. L’union a été confirmée par la réduction de la longueur et du territoire des petits vaisseaux (<0.5 mm). À un suivi moyen de 40 mois, une seule nécrose avasculaire a été trouvé. Le score de Murley Constant moyen était 87 (67–100) points alors que le score fonctionnel en comparaison de l’épaule non affectée était 94% (89–100%). En dépit du petit nombre de malades étudiés, la fixation trans-osseuse paraît conserver la vascularisation restante de la tête humérale.

References

  1. 1.
    Brooks CH, Revell WJ, Heatley FW (1993) Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study. J Bone Joint Surg Br 75:132–136PubMedGoogle Scholar
  2. 2.
    Cornell CN, Levine D, Pagnani MJ (1994) Internal fixation of proximal humerus fractures using the screw-tension band technique. J Orthop Trauma 8:23–27PubMedGoogle Scholar
  3. 3.
    Duparc F, Muller JM, Friger P (2001) Arterial blood supply of the proximal humeral epiphysis. Surg Radiol Anat 23:185–190PubMedGoogle Scholar
  4. 4.
    Esser RD (1994) Treatment of three- and four-part fractures of the proximal humerus with a modified cloverleaf plate. J Orthop Trauma 8:15–22PubMedGoogle Scholar
  5. 5.
    Gerber C, Schneeberg AG, Vinh TS (1990) The arterial vascularization of the humeral head: an anatomical study. J Bone Joint Surg Am 72:1486–1494PubMedGoogle Scholar
  6. 6.
    Hawkins RJ, Bell RH, Gurr K (1986) The three-part fracture of the proximal part of the humerus. J Bone Joint Surg Am 68:1410–1414PubMedGoogle Scholar
  7. 7.
    Hernigou P, Germany W (2002) Unrecognized shoulder joint penetration during fixation of proximal fractures of the humerus. Acta Orthop Scand 73:140–143CrossRefPubMedGoogle Scholar
  8. 8.
    Herscovici D Jr, Saunders DT, Johnson MP et al (2000) Percutaneous fixation of proximal humeral fractures. Clin Orthop 375:97–104CrossRefPubMedGoogle Scholar
  9. 9.
    Hintermann B, Trouillier HH, Schafer D (2000) Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br 82:1107–1112CrossRefPubMedGoogle Scholar
  10. 10.
    Hockings M, Haines J (2003) Least possible fixation of fractures of the proximal humerus. Injury 34:443–447PubMedGoogle Scholar
  11. 11.
    Jaberg H, Warner JJP, Jakob RP (1992) Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg Am 74:508–515PubMedGoogle Scholar
  12. 12.
    Jacob RP, Miniaci A, Anson PS et al (1991) Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br 73:295–298Google Scholar
  13. 13.
    Khodadadyan-Klostermann C, Raschke M, Fontes R et al (2002) Treatment of complex proximal humeral fractures with minimally invasive fixation of the humeral head combined with flexible intra-medullary wire fixation—introduction of a new treatment concept. Langenbecks Arch Surg 387:153–160CrossRefPubMedGoogle Scholar
  14. 14.
    Monin S, van Innis F (1999) Fractures of the proximal end of the humerus treated by the Kapandji centro-medullary nailing technique: a review of 21 cases. Acta Orthop Belg 65:176–181PubMedGoogle Scholar
  15. 15.
    Neer CS II (2002) Four segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg 11:389–399CrossRefPubMedGoogle Scholar
  16. 16.
    Rajasekhar C, Ray PS, Bhamra MS (2001) Fixation of proximal humeral fractures with the Polarus nail. J Shoulder Elbow Surg 10:7–10CrossRefPubMedGoogle Scholar
  17. 17.
    Resch H, Beck E, Bayley I (1995) Reconstruction of valgus-impacted humeral head fracture. J Shoulder Elbow Surg 4:73–80PubMedGoogle Scholar
  18. 18.
    Resch H, Povacz P, Fröhlich R, Wambacher M (1997) Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br 79:295–300CrossRefPubMedGoogle Scholar
  19. 19.
    Robinson CM, Page RS (2003) Severely impacted valgus proximal humeral fractures: results of operative treatment. J Bone Joint Surg Am 85:1647–1655CrossRefGoogle Scholar
  20. 20.
    Rosa MA, Maccauro G, Nizegorodcew T, Falcone G, Di Segni F (2002) Percutaneous elastic fixation of proximal humeral fractures: operative indications, techniques, results and complications. J Orthop Trauma 2:157–164CrossRefGoogle Scholar
  21. 21.
    Soete PJ, Clayson PE, Costenoble VH (1999) Transitory percutaneous pinning in fractures of the proximal humerus. J Shoulder Elbow Surg 8:569–573CrossRefPubMedGoogle Scholar
  22. 22.
    Yu KS, Chan PT, Lau SC et al (2002) Internal fixation of valgus-impacted humeral head fractures using the screw-wiring technique. Int Orthop 26:13–16CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Andreas M. Panagopoulos
    • 1
    Email author
  • P. Dimakopoulos
    • 1
  • M. Tyllianakis
    • 1
  • D. Karnabatidis
    • 2
  • D. Siablis
    • 2
  • A. X. Papadopoulos
    • 1
  • E. Lambiris
    • 1
  • P. Kraniotis
    • 2
  • G. Sakellaropoulos
    • 3
  1. 1.Department of OrthopaedicPatras University HospitalRio-PatrasGreece
  2. 2.Department of Interventional RadiologyPatras University HospitalRio-PatrasGreece
  3. 3.Department of Medical PhysicsPatras University HospitalRio-PatrasGreece

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