Abstract
The treatment of third proximal humerus complex fractures represents a challenge and osteosynthesis techniques are still controversial. The Authors report a new device that has been planned and used to treat this type of fracture, suitable for both young and elderly patients. The device consists of a perforated prismatic-triangular titanium cage (PTTC), available in different sizes so that it can be inserted in the bone cavity as a bridge. Thus, it supports the cephalic cap and, resting on the metaepiphyseal walls, allows greater and lesser tuberosities to be restored using osteosutures or minimal osteosynthesis devices. Furthermore, bone chips or bone substitutes can be inserted as filling in the perforated parts. From June 2005 to February 2006 we used this osteosynthesis surgical technique to treat 10 patients, 4 females and 6 males, all affected by proximal humerus complex fractures. No specific complications during and after surgery were noticed. The reported results are still to be considered as preliminary, but they are very encouraging. In all the cases the effective internal stabilisation allowed anatomical reduction of fragments, their stable fixation, reconstruction close to standard anatomy and early rehabilitation.
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References
Rockwood CA, Matsen FA (1990) Fractures in adults. In: The shoulder. JP Lippincott, Philadelphia, pp 722–950
Jakob RP, Miniaci A, Anson PS et al (1991) Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br 73:295–298
Stableforth PG (1984) Four-part fractures of the neck of the humerus. J Bone Joint Surg Br 66:104–108
Resch H, Hubner C, Schwaiger R (2001) Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head. Injury 32[Suppl 1]:SA25–SA32
Resch H, Povacz P, Frohlich R, Wambacher M (1997) Percutaneous fixation of three-and four-part fractures of the proximal humerus. J Bone Joint Surg Br 79:295–300
Paavolainen P, Bjorkenheim JM, Slatis P, Paukku P (1983) Operative treatment of severe proximal humerus fractures. Acta Orthop Scand 54:374–379
Kristiansen B, Christensian SW (1986) Plate fixation of proximal humeral fractures. Acta Orthop Scand 57:320–323
Speck M, Regazzoni P (1997) 4-fragment fractures of the proximal humerus. Alternative strategies for surgical treatment. Unfallchirurgie 100:349–353
Kuner EH, Siebler G (1987) Dislocation fractures of the proximal humerus-results following surgical treatment. A follow-up study of 167 cases. Unfallchirurgie 13:64–71
Hertel R (2005) Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16[Suppl 2]:S65–S72
Gerber C, Werner CM, Vienne P (2004) Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br 8:848–855
Compito C, Self E, Bigliani L (1994) Arthroplasty and acute shoulder trauma. Clin Orthop Relat Res 307:27–36
Neer CS II (1970) Displaced proximal humerus fractures: II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52:1090–1103
Tanner M, Cofield R (1983) Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. Clin Orthop Relat Res 179:116–128
Robinson CM, Page RS, Hill RM et al (2003) Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am 85:1215–1223
Neer CS II (1970) Displaced proximal humerus fractures: I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Moda SK, Chadha NS, Sangwan SS et al (1990) Open reduction and fixation of proximal humeral fractures and fracture-dislocations. J Bone Joint Surg Br 72:1050–1052
Zyto K, Ahrengart L, Sperber A, Tornkvist H (1997) Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 79:412–417
Hawkins RJ, Bell RH, Gurr K (1986) The three-part fracture of the proximal part of the humerus. Operative treatment. J Bone Joint Surg Am 68:1410–1414
Hawkins RJ, Kiefer GN (1987) Internal fixation techniques for proximal humeral fractures. Clin Orthop Relat Res 223:77–85
Cuomo F, Flatow EL, Maday MG (1992) Open reduction and internal fixation of two-and three-part displaced surgical neck fractures of the proximal humerus. J Shoulder Elbow Surg 1:287–295
Leyshon RL (1984) Closed treatment of fractures of the proximal humerus. Acta Orthop Scand 55:48–51
Lee CK, Hansen HR (1981) Post-traumatic avascular necrosis of the humeral head in displaced proximal humeral fractures. J Trauma 21:788–791
Vandenbussche E, Peraldi P, Naouri JF et al (1996) Four part valgus impacted fractures of the upper extremity of humerus: ilium graft reconstruction. Apropos of 8 cases. Rev Chir Orthop Reparatrice Appar Mot 82:658–662
Green A, Barnard WL, Limbird RS (1993) Humeral head replacement for acute, four-part proximal humerus fractures. J Shoulder Elbow Surg 2:249–254
Goldman RT, Koval KJ, Cuomo F et al (1995) Functional outcome after humeral head replacement for acute three-and four-part proximal humeral fractures. J Shoulder Elbow Surg 4:81–86
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Russo, R., Lombardi, L.V., Ciccarelli, M. et al. A new osteosynthesis device for the treatment of proximal humerus fractures. Description of the technique and preliminary results. Chir Organi Mov 91, 27–34 (2008). https://doi.org/10.1007/s12306-007-0005-4
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DOI: https://doi.org/10.1007/s12306-007-0005-4