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GLENOHUMERAL FRACTURES. SYNTHESIS, PROSTHESIS,ARTHROSCOPY: A COMPARISON OF DIFFERENT TECHNIQUES
PROSTHESIS ON FRATTURES
Assom M., Blonna D., Fantino G., Bruzzone M., Rossi R., Castoldi F.
Divisione Universitaria di Ortopedia e Traumatologia Università degli Studi di Torino Ospedale Mauriziano “Umberto I”, Torino
The treatment of complex proximal humeral fracture remains controversial. This is especially due to the difficulty to compare results from differents reports. In all proximal humerus fractures, the pattern of osseous disruption and its relationship to the surrounding blood vessels is important for determining treatment and predicting the risk of avascular necrosis. The arcuate artery is the intraosseous portion of the anterolateral branch of the of the anterior circumflex humeral artery. The blood supply to the humeral head in three-four part fractures depends on the integrity of this artery. The posterior circumflex artery provides a minor component of the amount of blood supply but essential in four part impacted valgus fracture. A precise definition of segments and the exact amount of displacement are important predictors of humeral head ischemia, but not of humeral necrosis. Neither the diagnosis of a four-part fractures, nor fracture-dislocations, head-spitting fractures, large impression fractures, calcar involvement and a disrupted medial hinge, are helpful to precisely predict necrosis, or low functional results after osteosynthesis. According to these observations, we suggest reduction and fixation as initial treatment in patients of less than 70 years with three- and four-part fractures and fracture-dislocations; we performed hemiarthroplasty in patients who have persistent late pain secondary to the fractures. Neverthe-less prosthetic replacement should be recommended immediately after trauma in patient older than 70 years with osteoporotic bones, poor bone stock, high risk of head ischemia or in case of intrarticular involvement.