Da Vinci System: clinical experience with complex proximal humerus fractures.

The purpose of this study is to report the clinical and radiographic outcomes after open reduction and internal fixation of displaced proximal humerus fractures with the "Da Vinci System". It is a triangle-shaped cage whose opposite faces are pierced, and it represents the evolution of a triangle-shaped bone block technique performed in a previous series of 33 patients. The new device is an interesting innovation to treat the difficult problem of fracture fragments reconstruction and stability, metaphyseal bone loss and proximal humerus revascularization. According to the technique, authors position the correct size titanium cage into the metaepiphysis, so that the fragments are reduced upon the cage, and they are stabilized with a minimal osteosynthesis by Kirschner wires, titanium screws or transosseous sutures. If the fracture line involves the proximal portion of the diaphysis, it is possible to use a short low profile plate. Between May 2005 and November 2009, we treated 71 patients (34 men and 37 women), even though we included in our study only 59 patients, who had a minimum follow-up of 12 months. The first patient has been treated in May 2005 and the last one in September 2008. The mean age was 60.8 years (minimum 27, maximum 78). There were 8 displaced 3-part fractures, 20 displaced 4-part fractures, 10 4-part fracture-dislocations, 5 head splitting, 12 unclassified multifragmentary fractures, 1 2-part fracture with multifragmentary calcar and 3 malunions of 4-part fracture. The functional results were evaluated by the Constant score. With a mean follow-up of 24 months (minimum 12, maximum 36 months), the mean Constant score was 80.25. The results were excellent or good in 48 cases, bad in 2 cases and satisfactory in 9; the mean active anterior elevation (AAE) was 160 degrees . All fractures but one healed; in one case, we had a deep infection after 80 days since the operation, treated with a preformed cement spacer.

Telegraph antegrade nailing in the treatment of humeral fractures with rotator interval split technique.

Twenty-four proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail. The purpose of this paper was to assess the clinical outcomes of proximal epiphyseal and diaphyseal humeral fractures treated with an antegrade humeral nail implanted after an interval rotator split. We treated six proximal epiphyseal fractures and seven bifocal fractures of the epiphysis and shaft and eleven diaphyseal fractures. The mean follow-up was 23 months (range 12 to 34 months). Twenty patients were available for follow-up. All but two fractures progressed to healing. The Mean Constant score was 80%, Relative Constant score was 95.5%. We divided the clinical outcomes by fracture pattern to define the best surgical indication. There were good clinical outcomes in all three groups, but the clinical score was highest in the shaft fracture group. An intramedullary antegrade nail inserted through the interval rotator without penetrating the rotator cuff had a good clinical outcome and with certain fracture types can be an effective and satisfactory device.

A new osteosynthesis device for the treatment of proximal humerus fractures. Description of the technique and preliminary results.

The treatment of third proximal humerus complex fractures represents a challenge and osteosynthesis techniques are still controversial. The Authors report a new device that has been planned and used to treat this type of fracture, suitable for both young and elderly patients. The device consists of a perforated prismatic-triangular titanium cage (PTTC), available in different sizes so that it can be inserted in the bone cavity as a bridge. Thus, it supports the cephalic cap and, resting on the metaepiphyseal walls, allows greater and lesser tuberosities to be restored using osteosutures or minimal osteosynthesis devices. Furthermore, bone chips or bone substitutes can be inserted as filling in the perforated parts. From June 2005 to February 2006 we used this osteosynthesis surgical technique to treat 10 patients, 4 females and 6 males, all affected by proximal humerus complex fractures. No specific complications during and after surgery were noticed. The reported results are still to be considered as preliminary, but they are very encouraging. In all the cases the effective internal stabilisation allowed anatomical reduction of fragments, their stable fixation, reconstruction close to standard anatomy and early rehabilitation.

The block-bridge system: a new concept and surgical technique to reconstruct articular surfaces and tuberosities in complex proximal humeral fractures.

Surgical treatment of complex displaced fractures of proximal humerus has changed in the last few years. Osteosynthesis has a high rate of nonunion, malunion, and avascular necrosis, and the results of hemiarthroplasty are not always functionally satisfactory. We report the results of a new technique for the reconstruction of the proximal humerus around a triangular-shaped bone block positioned inside the head and the metaphysis. The fragments are stabilized with minimal osteosynthesis by Kirschner wires, screws, or sutures. From 2001 to 2005, we treated 33 patients (20 men, 13 women) aged 34 to 74 years. The functional results were evaluated by the Constant score, with a mean follow-up of 24 months (range,12-36 months) The mean Constant score was 68 (range, 47-90). The results were excellent or good in 23 patients. The mean active anterior elevation was 160 degrees , all were pain free, and they returned to their preoperative activities, including sports. One patient had a symptomatic avascular necrosis that was treated with a hemiarthroplasty. The results show that this new technique has good clinical results with a low percentage of complications.

Displaced comminuted midshaft clavicle fractures: use of Mennen plate fixation system.

BACKGROUND: Surgical treatment of displaced comminuted midclavicular fractures includes open reduction and stabilization with wires, pins, or screwed plates. However, it is often difficult stabilizing small fragments, and there are several complications. The aim of this study was to assess an alternative technique using a Mennen plate. METHODS: From 1999 to 2004, we treated a cohort of 43 patients with a displaced three- or four-part midclavicular fracture. All patients were followed up at an average of 1 year after the injury: they had a functional evaluation and were assessed radiographically. RESULTS: The fractures of 41 patients had healed, with two cases of nonunion and no case of infection or osteomyelitis. All of them presented normal function of the shoulder and shoulder girdle symmetry. CONCLUSIONS: A Mennen plate is a good device for the treatment of displaced midshaft clavicle fractures. The technique is simple and the operation time is shortened; the bone architecture is protected by any damage caused by drill holes; and the endosteal blood supply is preserved as a result of the paraskeletal position of the plate.