Aim: The treatment of the fractures to three and four fragments of the humerus still represents a challenge. The authors describe the surgical technique and results with a modular prosthesis that permits an anatomical reconstruction of the proximal humerus from the calcarside, that becomes the point reference of reconstruction with the “Puzzle-Pieces” technique.

Methods: From February 2000 to February 2007 41 patients were treated with modular prosthesis. They were 8 males and 33 females aged between 56 and 79 years. In 23 cases the interested shoulder has been the right, in 18 the left. All fractures were diagnosed with X-ray and CT-scan. The type of fracture includes: 20 fractures of four fragments, 15 pluri-fragmentary fractures, and 6 fracture\dislocations. At the follow-up we evaluated 26 patients.

Results: The functional results were evaluated in 26 patients by Constant score with a mean follow-up of 4 years. All the patients reviewed have executed a X-Ray, while in 18 cases we also have evaluated the reconstruction of the tuberosities with CT-scan. In one case there has been had a complete resorption of the tuberosities with insufficiency of rotator cuff. The mean of forward elevation was 132° Conclusion: The plant of a humeral pros-thesis for fractures is a very complex intervention. The technique, for modular prostheses it’s not very codified. Moreover the results from the Literature are inconstant in particular as to function of the shoulder, not predictable and often were it accompanied by complications.

The technique we described consists in the identification and reconstruction of the medial part of calcar that becomes “the thread conductor” for restoration of the height and the retrotorsion of the humeral head.

Aim: The treatment of the fractures to three and four fragments of the humerus still represents a challenge.

The authors describe a surgical technique with a modular prosthesis that permits an anatomical reconstruction of the proximal humerus from the calcar-side, that becomes the point reference of reconstruction with the “Puzzle-Pieces” technique.

Methods: From February 2000 to February 2007, 41 patients were treated with modular prosthesis. They were 8 males and 33 females aged between 56 and 79 years. In 23 cases the interested shoulder has been the right, in 18 the left. All fractures were diagnosed with X-ray and CT-scan. The type of fracture includes: 20 fractures of four fragments, 15 pluri-fragmentary fractures, and 6 fracture\dislocations. At the follow-up we evaluated 26 patients.

Results: The functional results were evaluated in 26 patients by Constant score with a mean follow-up of 4 years. All the patients reviews have executed a X-Ray, while in 18 cases we also have evaluated the reconstruction of the tuberosities with CT-scan. In one case there has been had a complete resorption of the tuberosities with insufficiency of rotator cuff. The mean of forward elevation was 132°

Conclusion: The plant of a humeral prosthesis for fractures is a very complex intervention. The technique, for modular prostheses it’s not very codified. Moreover the results from the Literature are inconstant in particular as to function of the shoulder, not predictable and often were it accompanied by complications.

The technique we described consists in the identification and reconstruction of the medial part of calcar that becomes “the thread conductor” for restoration of the height and the retrotorsion of the humeral head.

Aim: To describe a new surgical technique for the reconstruction of complex fractures of the proximal humerus that can be used in both young and elderly patients. It consists in the anatomical reconstruction of fragments as puzzle with used of bone block and small fragment bone between the methaepiphiseal and head before a minimal osteosinthesis with K.-wire and or cannulated screws and or surure bone.

The goal of this technique is to restore normal anatomy of proximal humerus around a bone bridge inside the head and the metaphysis.

Methods: From 2003 to 2005 we treated 25 patients (17 males and 8 females), average 49.6, with a 3- or 4-part fractures and fracture\dislocations. The surgical technique requires a medial reconstruction with bone block insert and osteosyntesis with minimal encumbrance(k-wire and cannulated srews). In eleven cases we used autologus platelet growth factor

Results: All cases were submitted X-ray at 3months 6 months and 1 years. ten cases, also had TC scan. The functional results were evaluated according to the Constant score. With a mean follow-up of 24 months (range from 12 to 36 months), the results were excellent or good in 24 patients; the mean active forward elevation was 160 degrees. In one case we found a sintomatic avascular necrosis that was resolved with a hemiarthroplasty.

Discussion: Surgical management of acute complex proximal fracture of the humerus is still a challenge to the surgeons, both in young and in elderly patients.

The Authors report the goal of this technique is to restore normal anatomy of proximal humerus around a triangle-shaped bone block positioned inside between the head and the metaphyseal. The fragments are then stabilized with a minimal osteosynthesis by K- wires, screws or bone sutures.

The results of our study show that the technique we propose has good clinical and functional outcomes, with a low percentage of complications.

Aim: The authors report a new ostheosinthesis device(Prysmatic Threeangular System P.T.S.) designed for the treatment of complex fractures of the proximal part of the humerus.

Methods: From May 2005 to February 2006 we treated ten patients, four patients were female and six male. The average age was 45.1 years (max. 69, min. 27). Cases included nine fresh fractures and a malunion of three-part fracture treated three months after the trauma. All patients had closed fractures; one was worsened by a partial and temporary lesion of the brachial plexus. All patients underwent a standard X-ray and a Ct scan. In all patients, some homologous spongy bone was inserted in the titanium structure; moreover, in five cases (the youngest patients) autologous blood-derived growth factors were added. All patients were kept immobilized by means of a brace with internal rotation for 4 weeks.

Results: In 6 cases the follow-up period ranged from 3 months to a 10 months in 6 cases. In these cases the CT scan allowed as to determine that the integration of the bank bone with the receiver took place after 3–4 months, while the check performed at 6 months did not show any peri-metallic lysis and showed that the P.T.S. had perfectly integrated with the metaepiphysis. No cases of nervous or vascular secondary lesions were detected. No infections, either superficial or deep, were noticed even after a long period.

Discussion: The best surgical treatment of three- or four-part, dislocation and unclassifiable complex fractures of the humerus is still debated, the results achieved with other system or a shoulder prosthesis are not constant. The Authors report a new system consisting of a prismatic threeangular titanium structure which, allows to modulate the reduction of the parts and open a window from the fracture rim through which the surgeon can directly observe the lesion and the relevant parts.

Aim: In this work we report mild term clinical results of a consecutive series of 104 arthroscopic stabilizations for traumatic or non traumatic anterior-inferior shoulder instability treated using for the stabilization always poly- L-lactic acid Bioknotless anchors (Mitek, Nor-wood, Mass., USA) and surgical technique described by Thal, and the clinical results of 74 patients reviwed

Methods: From 2000 to 2005, 104 consecutive patients underwent arthroscopic capsuloplasty repair using bio-knotless anchors.14 cases were performed SLAP II by original reconstruction with bioknotless anchors. All the patient underwent preoperative a clinical examination and valued Constant and Rowe score, and subjected a X-Ray study and MRI o TC\ arthroTC scan. All patients were operated by same surgical team. 74 patients (55 male, 19 female) were reviewed with at least 20 months follow-up (20 – 60 months). Average age was 25 (18–45).

Results: Recurrence rate for instability was 6,7% (5/74). All recurrence, was associated with a large Hill-Sachs lesion and poor quality of capsular tissue. Overall, the results were good or excellent in 91,5% using the Rowe score. At X-ray study 28 cases have not show Samilson’s arthrosis, in 4 (14,7%) cases we observed geoid on glenoid side.

Conclusion: The improvement in the results, to use absorbable anchor, obtained could be related to the development of materials and in particular at use of PLLA (poly-L- lactic polymer) and PGACP (polygluconate co-polimer), at surgical techniques carried out, to the different fixation methods and not least to the different inclusion criteria used for the selection of patients.

Arthroscopic capsulolabral stabilization for the treatment of recurrent anterior shoulder instability repair using absorbable Knotless offers reliable results with respect to failure rate, range of motion, and shoulder function also at 4 years follow-up.

The percentage of rate for instability is 6,7% and is in accord with the International Literature on non resorbable anchors.