The study of effectiveness of PHILOS plate in the internal osteosynthesis of humeral head fractures.

Since 2006 23 patients with 24 humeral head fractures ere treated in our clinic. 10 of them were men (43,48%) and 13 women (56,52%). The average age was 50,4 years (range 16–89 years). Fractures of the surgical neck of humerus were 8 of these (33,33%), 12 were 3 parts fractures according to Neer classification (50%) and finally in 3 cases there was a 4 part fracture (16,66%). Shoulder of dominant upper limb was injured in most of the cases (68%).

19 patients (82,6%) were examined periodically in an average follow-up period of 19 months (range 13–26 months). All the fractures were healed. In 4 cases (16,66%) insufficient reduction was detected postoperatively. Constant score was calculated 12 months post-operatively up to 82,05 by mean (range 62–100). Differentiation was observed between the patients of age less than 60 years (12 patients with average constant score 91,25 with range from 78 until 100) and these of age of 60 years or more (7 patients with average constant score 71,43 with range from 62 until 81).

Internal osteosynthesis humeral head fractures with PHILOS plate is a reliable method of treatment not only for simple head fractures but also for them of 3 or even 4 parts, without complications and with very good functional results

Aims: To evaluate the functional recovery of the complex tibial plateau fractures Schatzker type V and VI treated with hybrid ex. fix..

Methods: Twenty-eight patients with intra-articular fractures of the proximal tibia were treated with hybrid external fixation in a three years period (1998–2001).The mean age was 35 years (17–76). According to Schatzker classification, there were 11(39.3%) fractures type V and 17(60.7) type VI, whereas 5(17.8%) fractures were open. Complex injury was recorded in 15(53.5%) patients. Closed reduction and hybrid external fixation was achieved in 21 (75%) fractures. Additional limited internal fixation was performed in 9(32%) cases. Open reduction was necessary in 7(25%) patients. Mobilization of the injured articulation was started at the 3rd postoperative day.

Results: Mean follow up period was 18 months. All fractures but one united at an average of 13.5 weeks (range from 11 to 18 weeks). The results were assessed according to the criteria of Honkonen and Jarvinen. An overall 22(78%) excellent and good results was recorded at the final follow up. Complications included one axial deformity, one septic pseudarthrosis, one peronial palsy and five pin tract infections.

Conclusions: The use of hybrid external fixation in the comminuted tibial plateau fractures (Schatzker V,VI), insure good restraining and early union, avoid major soft tissue complications and allow early mobilization and functional recovery of the knee joint.