THE TREATMENT OF COMMINUTIVE FRACTURES OF PROXIMAL HUMERUS WITH DISRUPTED AND DEVITALIZED HUMERAL HEAD BY OSTEOSYNTHESIS USING PHILOS PLATE. CONTROVERSIAL CASES ACCORDING TO PRINCIPLES STATED AT EFORT 2007

Abstract

Introduction: At EFORT 2007 – Thomazeau, Duparc and Hertel excellently formulated principles that may help to decide which types of comminuted dislocated fractures should be resolved by osteosynthesis and which ones by arthroplasty – regarding blood supply of the humeral head. In following section Baker, Shahid, Biberthaler, Farron and Kääb presented results of treatment of complicated fractures by Philos plate. The fact that emerging from these presentations is that using of angular stable implants may lead in many cases to the failure of osteosynthesis, especially in osteoporotic humeral head and/or small size of head.

In their presented work authors summarize the results of using Philos plate in ultimate indications. These are – dislocated proximal humeral fractures with abruption of the head in anatomical neck, where head fragment is so much thin and eventually osteoporotic, that fixation of any osteosynthetic component would be technically impossible. These cases include even situations where head fragment is then splitted into two major fragments.

Method: In our Clinic we have used the Philos plate in 54 cases during last four years. 11 cases of it were indications for arthroplasty according to general principles. In four of 11 cases head was abrupted into two major fragments, and in four of 11 cases head was completely separated from soft tissues and deprived of blood supply. Despite of that, there was performed a reconstruction by Philos plate considering low age of patients/range of age 26 to 54 years/as an attempt for humeral head preservation. Procedure was performed entirely by most experienced surgeons.

Results: Evaluation was performed 1 to 2 years after osteosynthesis. In all eleven cases full healing was found. In 4 cases there is clear remodelling of the head without any collapse of it. Also function of operated shoulder articulations enables the return of extremity functioning. We monitored no significant pain of the joint in any patients.

Conclusion: Angular stable implant allows an attempt for salvage of anatomical head even in cases with head disruption and devitalized fragment.

Presentation supported by grants MSMT CR 57/226010NPV, GA CR 106/04/1118 and FT–TA3/131