Ph. Chelius (Troyes, France)
Osteoporotic bone fracture is challenging surgeons even using new locking head screws devices:;in proximal humerus fracture, the difficulties are not in reducing but in stabilising for the healing time which needs few weeks;in the same time the surgical approach should not destroy the soft parts and the precarious vascularity of the fractured and displaced pieces of bone .
Since 2004 we try to stabilise the bone reduction and fixation using injectible phospho tri calcic(beta) bone substitute. The substitute is injected after bone reduction :the bone cement is injected inside the bone gap which is created by the reduction of impacted fractured bone pieces.
To preserve the vascularity of the bone pieces while reducing them under Xrays,we do a latero-superior approach which is more well adapted to get a good control and less soft parts destroying ;after injection we do a osteosynthesis with locking head screws devices .
15 cases of proximal humerus fractures have been operated by this method from 3parts fractures to dislocated fractures or articular fractures ;
The bone substitute stabilized the fracture so well we did not see any disturbing secondary displacement :we did not notice any adverse effect due to the substitut
The used volume of injection was between 5 to 10 cc .
The evolution of the substitut was good for all the cases ;the disappaerance is depending of the injected volume
The tri calcic phosphate (beta) is not a foreign body and does not disturb the creeping substitution described by many authors during the bone healing
Functional result is depending of the survey of the apophysis and this is moore frequent when they are fixed specifically to the metallic device (as in prosthetic surgery) after gentle reduction
We do believe that the use of a completely resorbable injectible bone substitut filling the bone gap due to the anatomical reduction added to a gentle latero-superior approach and a locking head screws device is most of time the best way to preserve the function and avoid the need of prosthetic surgery