OBJECTIVE: Exercise-stable internal fixation of unstable fractures of the proximal humerus. INDICATIONS: Unstable humeral head fractures with two to four fragments. Unstable fractures of the proximal humerus. Pseudarthroses of the proximal humerus. CONTRAINDICATIONS: Stable proximal humerus fractures (impacted, dynamic stability confirmed by image intensifier). Dislocated fractures with rupture of the nutrient arteries to the region of the humeral head. Fractures with headsplit. Relative: incomplete or nonexistent bone stock around the nail insertion site in the region of the humeral head. SURGICAL TECHNIQUE: Exposure of the nail insertion site at the apex of the humeral head by division of the deltoid muscle and short incision of the supraspinatus tendon posterior to the biceps tendon. Open or closed reduction and extraction of a cylindrical bone segment ready for nail insertion through the humeral head. The nail is advanced into the humeral shaft and locked in the humeral head with four proximal interlocking screws and into the diaphysis with two fixation screws inserted with the help of the targeting device. Exact monitoring of implant position using the image intensifier to ensure that the implant is not protruding. Closure of the rotator cuff and transosseous refixation of the deltoid muscle to the acromion. POSTOPERATIVE MANAGEMENT: Gilchrist bandage for a few days or for 4 weeks in noncompliant patients preventing to lean on the operated arm. External rotation is restricted to 15 degrees for 6 weeks. All other movements are permitted up to the pain threshold. Physiotherapeutic treatment to prevent adhesions in the subacromial space. RESULTS: From December 2000 to spring 2004, 133 patients (average age: 74.9 years) with 137 unstable proximal humeral fractures were treated surgically. 97 patients with 99 operated shoulders were followed up for at least 7 months. The patients' average age at follow-up was 74.9 +/- 13.6 years (20-102 years). A Constant Score of 60.0 +/- 16.8 points was achieved and 84.8 +/- 19.4% and 84.0 +/- 15.5% on the age- and gender-related as well as side-related Constant Scores.
OBJECTIVE: Exercise-stable internal fixation of unstable fractures of the proximal humerus. INDICATIONS: Unstable humeral head fractures with two to four fragments. Unstable fractures of the proximal humerus. Pseudarthroses of the proximal humerus. CONTRAINDICATIONS: Stable proximal humerus fractures (impacted, dynamic stability confirmed by image intensifier). Dislocated fractures with rupture of the nutrient arteries to the region of the humeral head. Fractures with headsplit. Relative: incomplete or nonexistent bone stock around the nail insertion site in the region of the humeral head. SURGICAL TECHNIQUE: Exposure of the nail insertion site at the apex of the humeral head by division of the deltoid muscle and short incision of the supraspinatus tendon posterior to the biceps tendon. Open or closed reduction and extraction of a cylindrical bone segment ready for nail insertion through the humeral head. The nail is advanced into the humeral shaft and locked in the humeral head with four proximal interlocking screws and into the diaphysis with two fixation screws inserted with the help of the targeting device. Exact monitoring of implant position using the image intensifier to ensure that the implant is not protruding. Closure of the rotator cuff and transosseous refixation of the deltoid muscle to the acromion. POSTOPERATIVE MANAGEMENT: Gilchrist bandage for a few days or for 4 weeks in noncompliant patients preventing to lean on the operated arm. External rotation is restricted to 15 degrees for 6 weeks. All other movements are permitted up to the pain threshold. Physiotherapeutic treatment to prevent adhesions in the subacromial space. RESULTS: From December 2000 to spring 2004, 133 patients (average age: 74.9 years) with 137 unstable proximal humeral fractures were treated surgically. 97 patients with 99 operated shoulders were followed up for at least 7 months. The patients' average age at follow-up was 74.9 +/- 13.6 years (20-102 years). A Constant Score of 60.0 +/- 16.8 points was achieved and 84.8 +/- 19.4% and 84.0 +/- 15.5% on the age- and gender-related as well as side-related Constant Scores.
Authors: M H Hessmann; S Nijs; T Mittlmeier; M Kloub; M J M Segers; V Winkelbach; M Blauth Journal: Oper Orthop Traumatol Date: 2012-09 Impact factor: 1.154
Authors: Christian Max Günther; Peter Ernst Müller; Wolf Mutschler; Christoph Martin Sprecher; Stefan Milz; Volker Braunstein Journal: Patient Saf Surg Date: 2014-04-22