Open reduction and internal fixation of three- and four-part proximal humeral fractures by intrafocal distraction: a cli
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ORIGINAL PAPER
Open reduction and internal fixation of three- and four-part proximal humeral fractures by intrafocal distraction: a clinical and radiographic study of thirty-two cases with five to ten years of follow-up Levon Doursounian 1
&
Julien Gaillard 1 & Olivier Lauthe 1 & Alain Sautet 1 & Adeline Cambon-Binder 1
Received: 12 March 2020 / Accepted: 9 June 2020 # SICOT aisbl 2020
Abstract Purpose The disadvantage of ORIF of proximal humerus fracture (PHF) by intrafocal distraction is that once the device is inserted, it cannot be removed. This study was designed to evaluate the tolerance of such a titanium alloy device at five years of minimal follow-up (FU) and secondarily to assess the relevance of the osteosynthesis of these fractures. Method Thirty-two patients operated for PHF and implanted with a titanium alloy device between 2009 and 2011 were reviewed: fifteen three-part fracture (3-PF) with mean age 65.2 ± seven years and mean FU at 86 months, and seventeen four-part (4-PF) with mean age 62.9 ± 12 years and mean FU at 88 months. Results There were no signs of clinical or radiological incompatibility to the metal. The lateral cortex of the humeral shaft at the wedge component level of the device was thinner than pre-operatively in half of the cases. For the fifteen 3-PF, the median raw and weighted constant score (CS) were 75 and 100, respectively. Only one case presented avascular necrosis (AVN). For the seventeen 4-PF, the median raw and weighted CS were 64 and 88, respectively. Seven cases presented AVN and none of them seven had initially a dorsomedial metaphyseal extension of the humeral head. Kaplan–Meier survivorship analysis, with 95% confidence interval, was calculated at 89.7% (79.7–100%) survivorship at 7.18 years of follow-up. Conclusions This study shows no incompatibility of the titanium alloy device, radiological signs of localized stress shielding in half of the cases with no functional impact, excellent clinical and radiological evolution of the 3-PF, and AVN in all 4-PF without dorsomedial metaphyseal extension of the humeral head whereas most of cases without AVN had dorsomedial metaphyseal extension. Keywords Intrafocal distraction . Proximal humerus fracture . ORIF . Titanium biotolerance
Introduction * Levon Doursounian [email protected] Julien Gaillard [email protected] Olivier Lauthe [email protected] Alain Sautet [email protected] Adeline Cambon-Binder [email protected] 1
Department of Orthopedic Surgery and Traumatology, Saint Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
The osteosynthesis of proximal humerus fractures (PHF) type 3 and 4 of the Neer classification [1] remains controversial [2–4]. Intrafocal distraction osteosynthesis with the JUST UNIC® implant proposes a different option to solve the mechanical problem posed by these fractures and has several advantages over intramedullary nails or osteosynthesis plates with screws [5]. The only theoretical drawback is that the synthesis material rema
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