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

The weak points and complications of the classic spacers are eliminated by the construction of an articulated spacer. We did have very good results with the application of a classic spacer and considered the negative properties of the articulated spacer as a foreign matter in the wound. Gradually, the excellent literary results, standardization of the procedure, faster rehabilitation and a significant growth of comfort for the patient convinced us of the fact, that we chose the right way. Therefore we prepared and verified the new implant. In its construction we used the experience from the creation of classic spacers as well as the principle of a drained spacer allowing a drainage of the cavity of the femur. The implant is constructed as a module to be enwrapped by as large amount of the bone cement with an antibiotics as possible. The cup is flat with a diameter of 42 mm, with grooves allowing adhesion of as large a quantity of cement as possible with the articular area for the head of a diameter of 28 mm. For a better stability of the implant, it is constructed as antiluxation one. The implant stem consists of three parts so that a high modularity is secured upon low costs. The body of the stem has a single length and it is furnished in the axis with a drain enabling the use of a flush lavage. For a better modularity, it is possible to fit on the stem body three different lengths of the neck. In 2002 and 2004, the articulated spacer was used to treat 26 patients with a deep infection of a hip joint prosthesis. The treatment of the infection has been successful in all cases. The period of leaving the drained articulated spacer was 12,8 weeks. The result of the Harris hip score when after implantation it reaches on average 94.7 points. The contribution of this method is also supported by an even more average growth of the Harris hip score as opposed to the condition prior to operation, which was 37,5 points. The patients did not feel any pain in between the operations. The only restriction of the quality of life was brought by a recommended necessity of walking with crutches. The technique combines the advantages of a two-stage procedure with flexibility of the reimplanting term and the economic and social profits for the patient.