A practical guide for the use of contour locking plates for the repair of humeral diaphyseal fractures with proximal extension.

INTRODUCTION: The emergence of minimally invasive techniques has expanded the use of plates and improved their safety for the repair of humeral diaphyseal fractures with proximal extension. In this study, we aimed to determine the best contouring method for long locking plates in the repair of humeral fractures using this approach. PATIENTS AND METHODS: Comparative observations were performed between helical and spiral modelling in plastic models to identify which shape best fits the contours of the humerus. To determine the best shape, we attempted to assess the torsion required for the plate to settle laterally in the greater tuberosity and anteriorly in the diaphyseal region of the humerus. After establishing the best approach, we transferred the method to two anatomical specimens and confirmed the viability of the method and pathways. Additionally, to confirm the clinical applicability of the method, we applied the method in ten patients. RESULTS: After placing the plates in the bone models, it was found that the helical plate was more distant from the bone. On the other hand, the spiral plate achieved better accommodation along the contours of the humerus. The amount of twist was tested at 50°, 70° and 90°. When the plate was twisted at 70°, it maintained contact with the greater tuberosity proximally and the anterior cortical diaphyseal region. Eight patients completed the follow-up. Radiographic consolidation and good functional outcomes were achieved in all patients. CONCLUSIONS: Spiral modelling at 70° allows anatomical accommodation at the greater tuberosity proximally and in the diaphyseal region.

Late postoperative analysis of the tip-apex distance (TAD) in pertrochanteric fractures: is there an accommodation of the implant within the bone?

INTRODUCTION: This study measured the tip-apex distance (TAD) values in the immediate postoperative period and following weight-bearing and fracture impaction in patients undergoing osteosynthesis with dynamic hip screw and cephalomedullary nail. OBJECTIVE: To correlate the Baumgaertner index in the immediate postoperative period with values obtained after impaction of the fracture with the accommodation of the cephalic implant in the femoral head. PATIENTS AND METHODS: Radiographic TAD measurements were taken with AGFA-VIEW® of 82 patients with a mean age of 72 years with pertrochanteric fractures who were operated on and the fracture fixed with DHS- Synthes®, TFN-Synthes®, or Gamma Nail III-Stryker® in the immediate postoperative period, and following weight-bearing and fracture impaction (mean 3-8 weeks after surgery). RESULTS: The overall average TAD decreased from 20.3mm to 18.2mm. Regardless of the instability of the fracture, the age of the patient or the implant used, TAD decreased between the immediate postoperative period and following fracture impaction. CONCLUSION: The osteosynthesis of pertrochanteric fractures was associated with important accommodation of the cephalic implant in the femoral head with decreased TAD values after weight-bearing.