RESUMO
Proximal humerus fractures are common problems plaguing in geriatric population. Approximately half of all proximal humeral fractures occur due to fall usually at ground level. (Low velocity trauma). In younger individuals fractures occurring because of higher-energy trauma such as a fall from a height, motor vehicle accidents, sports, or assaults. The proximal humerus fracture because of three loading modes: compressive loading of the glenoid onto the humeral head, bending forces at the surgical neck, and tension forces of the rotator cuff at the greater and lesser tuberosities. Most proximal humeral fractures are treated nonoperatively. However, surgical treatment is becoming more popular, with development of modern implant (PHILOS plate). Implant failure is common complication occur due to improper fixation, osteoporotic bone, early mobilization, non-union and varus malalignment. Various modality available for its management i.e., Hemiarthroplasty, reverse shoulder arthroplasty and ORIF + bone graft. IN this case report 60-year male patient with right side proximal humerus fracture treated with PHILOS plating. At 6 week follow up radiograph suggest implant failure. Patient was posted for revision surgery ORIF + platting and fibular strut graft was done.
RESUMO
Between 1982 and 1991, 33 cases(47 patients) with Ficat stage I and II avascular necrosis of the femoral head which had decompression with fibular strut grafting were followed up for average 62 months ranging from 36 to 136 months, The authors analyzed the results by Harris Hip Score(H.H.S) clinically and according to Ficat stage progression radiologically and evaluated the effectivencess of this procedure in the early stage of atraumatic avascular necrosis of the femoral head. The results were as follows. 29 hips were mon, 4 hips were women and 11 patients were bilateral. The ages ranged from 26 to 75 years and the mean age was 46.6 years. By the radiological classification of Japnese Investigation Committee, 23 hips(79%) of stage II showed diffuse involvement of the femoral heads(type 1-C, 2, 3-B). By Ficat stage, stage I were 4(12%) and stage II were 29(88%). At follow up, 2 hips were in stage I(6%), 15 hips were in stage II(46%), 11 hips were in stage III(33%) and 5 hips showed stage IV (15%). Two hips were converted to total hip arthroplasty due to failure. Preoperative Harris Hip Score was 84 points in average and at most recent follow up, the score was 89 points in average. The clinical surccess rate was 73% and radiological success rate was 52%, but 83% of the patients were satisfied with the procedure subjectively. There noted some disparity between the clinical and raiological results, but the effect of the decompression with fibular strut grafting will be known if more long term follow up is available.