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Humerus head osteonecrosis in surgical treatment intraarticular fractures of proximal humerus by PHILOS plate


Authors: Radek Pikula;  Daniel Ira;  Milan Krtička;  Michal Mašek;  Petr Nestrojil
Authors‘ workplace: Oddělení dětské onkologie FN Brno ;  Tramacentrum FN Brno
Published in: Úraz chir. 21., 2013, č.3

Overview

INTRODUCTION:
Intra-articular humeral head fractures face a high risk of humeral head osteonecrosis development. Reduced bone quality in the area of humeral head and osteoporosis in older patients limit the options of successful osteosynthesis.

MATERIAL AND METHODS:
A total of twenty-nine patients with intra-articular proximal humerus fractures treated surgically by LCP plate (PHILOS®) at our department from 2009 to 2013 were included in our study. All patients underwent X-ray and CT examination and the fractures were classified according to the AO classifiication. Predictors of the humeral head ischemia defined by Hertel in 2004 (length of the metaphyseal calcar segment less than 8 mm, disruption of the medial hinge, fractures of the anatomical neck, four-fragments fractures, head angulation over 45 degrees, displacement of tuberosities over 10 mm, glenohumeral dislocation and head-split component) were used for further assessment of patients with humeral head osteonecrosis (partial or complete).

RESULTS:
Humeral head osteonecrosis occurred in 10 out of 29 cases (34.5 %). Complete head osteonecrosis with the collapse and resorption was noted only in 1 case (3.4 %). C3 fractures were affected by osteonecrosis in 55.6 % of cases, C2 fractures in 27.8 %. No avascular necrosis was noted in the C1 fracture group. Predictors of humeral head ischemia, i.e. length of the metaphyseal calcar segment less than 8mm, disruption of the medial hinge, fractures of the anatomical neck and four-fragments fracture were found in the case of complete humeral head osteonecrosis. Most of the predictors (70-100%) have occurred in fractures with developed partial head osteonecrosis.

CONCLUSION:
The risk of osteonecrosis is considerably higher in C type fractures. Patients with humeral head osteonecrosis reached a significantly worse functional outcome and required more revision operations. Evaluation of humeral head ischemia predictors is important for the prognosis of fracture healing and for assessing the risk of head osteonecrosis. Fractures with highly predictable humeral head necrosis should be considered for primary hemiarthroplasty.

Key words:
osteonecrosis, PHILOS plate, screw cut-out, predictors of humeral head ischemia.


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