A NEW CONCEPT AND SURGICAL TECHNIQUE FOR THE RECONSTRUCTION OF COMPLEX FRACTURES OF THE PROXIMAL HUMERUS.

Abstract

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.