SALVAGE OF THE HUMERAL HEAD IN THE COMPLEX FRACTURES: SURGICAL TECHNIQUE WITH A NEW DEVICE AND PRELIMINARY REPORTS

Abstract

Purpose: The purpose of this study is to report the preliminary outcomes after open reduction and internal fixation of displaced proximal humerus fractures with a new device called “Da Vinci System^® (Arthrex)”. It is a triangle-shaped titanium cage whose opposite faces are pierced and represents the evolution of a triangle-shaped bone block technique performed in a previous series of 33 patients.

Material and methods: Between May 2005 and May 2008 we treated 54 patients (26 males and 28 females), even though we included in our study 36 patients who had a minimum follow-up of 12 months. The mean age was 60.3 years. The fractures were classified according to Neer. According to the technique, the Authors position the correct size titanium cage into the metaepiphysis, so that the fragments are reduced upon the cage and are stabilized with a minimal osteosynthesis by Kirschner wires, titanium screws or transosseous sutures.

Results: The functional results were evaluated by the Constant score; with a mean follow-up of 22 months (minimum 12, maximum 36 months), the results were excellent or good in 34 cases, bad in 1 case; the mean active anterior elevation was 165 degrees, while in one case a polar necrosis is present but clinical asymptomatic.

All fractures but one healed; in one case, 80 days after the operation, we had a deep infection treated with a self-customed cement spacer.

Discussion: Surgical management of displaced proximal humerus fractures is still a challenge to surgeons. Optimal fixation system remains controversial, especially in complex fractures with instable fragments and osteoporotic bone. The Authors underline it is important to reconstruct the medial part of the surgical neck, to fill the bone defect, and to provide stable osteosynthesis. The “Da Vinci System” is an interesting innovation to treat difficult problems such as fracture fragments reconstruction and stability, metaphyseal bone loss and proximal humerus revascularization.