Internal Osteosynthesis of Humeral Head Fractures With PHILOS Plate

1. 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

2. shoulder variety of movements range of movements  painfull decreased movement  cost generally Humeral Head Fractures

3. 5% of all # elderly ( + osteoporosis) longer living higher incidence morbidity

4. causes Elderly : fall on extended upper limb Younger : high energy injury + epilepsy etc electric shock sport injury direct force

5. 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.

6. treatment initially: • closed reduction (traction, plaster, abduction splints) early 30’s • surgical treatment 50’s • humeral head replacement 70’s • plate-screws (AO/ASIF)

7. 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.

8. stable + extra-articular + minimally displaced #  early mobilization  supportive therapy better functional result displaced # conservative treatmentlimited function

9. surgical aim bone & soft tissue healing with best functional result fracture compromised humeral head vasqularity AV.N. 34% / 3-part 90% / 4-part

10. displaced intra-articular fractures • fracture personality (bone quality, fracture patern, soft tissues) • patient personality • surgeon’s personality

11. indications of surgical treatment articular surface, GT, MT, surgical neck • displacement ≥ 1 cm • angulation ≥ 45° • lately: displacement ΜΒΟ ≥ 5 mm

12. aim is PHILOS plate effective in treatment of humeral head fractures ?

13. PHILOS plate

16. deltopectoral approach • operative time 58 min (38-87 min) • C-arm • blood transfusion = 0 • mobilization on 2nd p.op. day

18. surgical neck # ORIF with PHILOS plate

19. 3 and 4-part # • PHILOS plate (ORIF of surgical neck #) • bone suturing (for GT, LT) • free screws +washer (GT osteosynthesis in 2 cases)

22. mal-reduction & malunion humeral head displacement • 2 pts : 0,5 - 1cm medially • 1 pts : posteriorly • 1 pt : medially + ≈15οvarous

26. Ν. D. 33y 4-part with GT comminution 1 m

27. 2 m 4 m

28. implant failure • 1 pt : revision of ORIF (new PHILOS plate)

29. Κ. P. 42y surgical neck #

30. 3 w 2nd operation 3 m

31. results

33. P. P. 16 y surgical neck #

34. 1m

35. 4m

36. 1y

37. Κ.Α. 51y 3-part

38. 2 m

39. 1 y

40. Χ. T. 60y 4-part

41. 1 y

42. T. Β. 50y 3-part

43. 1 y

45. < 60 y: 1 pt (5,26 %) • impingement (high position of plate)

46. ≥ 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

47. S.D., 67y 4-part

48. 5 m semi-arthroplasty

49. 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.

50. thank you