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Internal Osteosynthesis of Humeral Head Fractures With PHILOS Plate. E. ATHANASELIS, J. GLIATIS, P. MPOUGAS, M. TYLLIANAKIS ORTHOPAEDIC Dpt UNIVERSITY HOSPITAL OF PATRAS, GREECE DIRECTOR: prof. P. DIMAKOPOULOS www.orthopatras.gr. shoulder variety of movements range of movements
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Internal Osteosynthesis of Humeral Head Fractures With PHILOS Plate E. ATHANASELIS, J. GLIATIS, P. MPOUGAS, M. TYLLIANAKIS ORTHOPAEDIC Dpt UNIVERSITY HOSPITAL OF PATRAS, GREECE DIRECTOR: prof. P. DIMAKOPOULOS www.orthopatras.gr
shoulder variety of movements range of movements painfull decreased movement cost generally Humeral Head Fractures
5% of all # elderly ( + osteoporosis) longer living higher incidence morbidity
causes Elderly : fall on extended upper limb Younger : high energy injury + epilepsy etc electric shock sport injury direct force
identification Hippocrates 460 π.Χ. traction Krocher 1869 classification Codman 1934 4-part classification (epiphyseal lines) Neer 1970 classification based on anatomical, biomechanical and therapeutical criteria Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. Sep 1970;52(6):1077-89.
treatment initially: • closed reduction (traction, plaster, abduction splints) early 30’s • surgical treatment 50’s • humeral head replacement 70’s • plate-screws (AO/ASIF)
biological & M.I. internal osteosynthesis • further improvement of prosthesis Dimakopoulos P, Potamitis N, Lambiris E. Hemiarthroplasty in the treatment of comminuted intraarticular fractures of the proximal humerus. Clin Orthop. Aug 1997;(341):7-11. Hartsock LA, Estes WJ, Murray CA. Shoulder hemiarthroplasty for proximal humeral fractures. Orthop Clin North Am. Jul 1998;29(3):467-75.
stable + extra-articular + minimally displaced # early mobilization supportive therapy better functional result displaced # conservative treatmentlimited function
surgical aim bone & soft tissue healing with best functional result fracture compromised humeral head vasqularity AV.N. 34% / 3-part 90% / 4-part
displaced intra-articular fractures • fracture personality (bone quality, fracture patern, soft tissues) • patient personality • surgeon’s personality
indications of surgical treatment articular surface, GT, MT, surgical neck • displacement ≥ 1 cm • angulation ≥ 45° • lately: displacement ΜΒΟ ≥ 5 mm
aim is PHILOS plate effective in treatment of humeral head fractures ?
deltopectoral approach • operative time 58 min (38-87 min) • C-arm • blood transfusion = 0 • mobilization on 2nd p.op. day
surgical neck # ORIF with PHILOS plate
3 and 4-part # • PHILOS plate (ORIF of surgical neck #) • bone suturing (for GT, LT) • free screws +washer (GT osteosynthesis in 2 cases)
mal-reduction & malunion humeral head displacement • 2 pts : 0,5 - 1cm medially • 1 pts : posteriorly • 1 pt : medially + ≈15οvarous
Ν. D. 33y 4-part with GT comminution 1 m
2 m 4 m
implant failure • 1 pt : revision of ORIF (new PHILOS plate)
Κ. P. 42y surgical neck #
3 w 2nd operation 3 m
P. P. 16 y surgical neck #
Κ.Α. 51y 3-part
Χ. T. 60y 4-part
T. Β. 50y 3-part
< 60 y: 1 pt (5,26 %) • impingement (high position of plate)
≥ 60 y: 3 pts (15,8%) (3 and 4-part #) • limited and painful flexion & abduction • rotator cuff dysfunction 1 pt (5,3%) (4-part #) • limited and painful ROM of shoulder • AV.N. of humeral head shoulder semi-arthroplasty
S.D., 67y 4-part
5 m semi-arthroplasty
conclusions PHILOS plate is a reliable solution in humeral head fractures’ ORIF It can be applied: 2, 3 and 4-part # without significant complications, giving very good functional results.