Le fratture della testa omerale trattate con il “sistema Da Vinci”

Abstract

The purpose of this study is reporting clinical and radiographic outcomes after open reduction and internal fixation of displaced proximal humerus fractures with the “Da Vinci System®”. This new device is an interesting innovation to treat the difficult problem of fracture fragments reconstruction and stability, metaphyseal bone loss and proximal humerus revascularization.

Between May 2005 and May 2008 we treated 51 patients (24 males and 27 females), but in our study only 29 patients, who had a minimum follow-up of 12 months, were included. Mean age was 60,3 years. There were four displaced 3-part fractures, seven displaced 4-part fractures, four anterior dislocated 4-part fractures; in fourteen cases we could not identify the fracture according to Neer, and so we refer to “multifragmentary fractures”. According to the original technique, we position the correct size titanium cage into the metaepiphysis, so that the fragments are reduced upon the cage and they are stabilized with a minimal osteosynthesis by Kirschner wires, titanium screws or transosseous sutures.

Functional results were evaluated by the Constant score; with a mean follow-up of 24 months (minimum 12, maximum 36 months), the results were excellent or good in 28 cases, bad in 1 case; mean active anterior elevation was 165° degrees. All fractures but one healed; in one case a deep infection developed 80 days after the operation and was successfully treated with a customed cement spacer.

The “Da Vinci System” allows a good reduction and a stable fixation in the treatment of displaced proximal humeral fractures, even in elderly patients with osteoporosis. The results demonstrate minimum residual functional impairment.