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Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 40 - 40
1 Mar 2009
Biberthaler P Braunstein V Kirchhoff C Kroetz M Kettler M Mutschler W
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Background: Fractures of the humeral head are a relevant problem in orthopedic surgery and the optimal therapeutic strategy of displaced fractures remains debated controversially in literature. In this respect, a special locking-plate was designed recently for the humerus to improve fixation of open reduction. However, analysis of larger series are still missing. Hence, the aim of this study was to analyze prospectively all patients suffering from humeral head fractures which were stabilized by the internal fixation system PHILOS (Synthes).

Patients and Methods: From 01/2002 until 08/2005 225 displaced humeral head fractures were treated by PHILOS plates. The fractures were classified according to the classification of Neer. Mean observation period was 9 months postoperative. For clinical evaluation the constant score was calculated after a mean observation period of 9 months. Moreover, an X-ray was performed in two plains to judge the implant position. From the total collective of 225 patients, an amount of 176 patients were enclosed into the clinical evaluation. The others were either deceased, or could not be contacted for other reasons.

Results: Out of the enrolled 176 patients into the follow-up study, 35% were Neer III, 43% were Neer type IV/V-3, and Neer type IV/V-4 were found in 12% beside 10% others. After 9 months, the mean constant score was absolute 75 ± 17 points. In direct postoperative X-ray of the 225 patients, a correct reduction and adequate axis between head and shaft was found in 92% of the patients. However, in 14% incorrect implant position was present in terms of intraarticular screws (11%) and elevated plate position in 6 cases. Moreover, after 9 months 8 patients demonstrated secondary implant dislocation, 3 of the head and 5 of the shaft and 14% suffered from secondary screw perforation into the joint due to humeral head sintering. Complete necrosis of the humeral head was present in 5 cases whereas partial necrosis was proven in 9 patients. Since sometimes, several complications were present in a single patient, the total amount of complication cases was 29 and these patients required secondary surgery.

Conclusion: The PHILOS locking plate system allows for an reliable internal fixation of humeral head fractures presenting a reasonable low complication rate. However, surgical pearls comprise mandatory cerclages of both tubercula framed onto the plate and correct axis of humeral head reposition. Typical pitfalls are intraarticular screws, secondary sintering and mislead anticipation of the stronghold of screw fixation in the bone by the locking mechanism. An randomized prospective study is currently on the way to further illuminate the quality of locking plate systems in the humeral head.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 1 | Pages 103 - 106
1 Jan 2008
Kettler M Tingart MJ Lunger J Kuhn V

Operative fixation is the treatment of choice for a rupture of the distal tendon of biceps. A variety of techniques have been described including transosseous sutures and suture anchors. The poor quality of the bone of the radial tuberosity might affect the load to failure of the tendon repair in early rehabilitation.

The aim of this study was to determine the loads to failure of different techniques of fixation and to investigate their association with the bone mineral density of the radial tuberosity.

Peripheral quantitative computed tomography was carried out to measure the trabecular and cortical bone mineral density of the radial tuberosity in 40 cadaver specimens. The loads to failure in four different techniques of fixation were determined.

The Endobutton-based method showed the highest failure load at 270 N (sd 22) (p < 0.05). The mean failure load of the transosseous suture technique was 210 N (sd 66) and that of the TwinFix-QuickT 5.0 mm was 57 N (sd 22), significantly lower than those of all other repairs (p < 0.05). No significant correlation was seen between bone mineral density and loads to failure.

The transosseous technique is an easy and cost-saving procedure for fixation of the distal biceps tendon. TwinFix-QuickT 5.0 mm had significantly lower failure loads, which might affect early rehabilitation, particularly in older patients.