2006 - UZ Leuven

VAN GESTEL L., NIJS S., BROOS P.: Tubercle fixation in proximalhumeral fractures: biomechanical evaluation. Eur. J. Trauma, 2006; 32:780 (Abstract).Introduction: Previous studies clearly demonstrated a correlationbetween functional outcome after shoulder fracture prosthesis andfunctional outcome. In a previous multicenter study of our workinggroup tubercle healing was associated with a mean absolute Constantscore of 77, where in the non-healed group only a score of 48 wasobserved. Multiple studies however did demonstrate that only, at best,half of the refixated tubercles do heal. We do believe that stability offixation is one of the main determinants whether a tubercle will heal ornot.Material and methods: We did create a standardized four partproximal humeral fracture in 8 cadaveric proximal humeri with intactrotator cuff attached to the bone. In all humeri an Articula fractureshoulder prosthesis (Mathys Betlach) has been implanted. In fourhumeri the tuberculae were fixed upon the prosthesis using nr. 2Fibrewire. In four other humeri the fixation was achieved using acircular 2 mm metal cable (Dall-Miles Howmedica). Using an highspeed camera setup interfragmentary dislocation was measured afterputting an alternated load on the subscapuaris, supraspinatus andinfraspinatus tendons.Results: The construct using the cable was significantly more stable inall directions as the construct using Fibrewire.Conclusions: As interfragmentary stability is an condition for fracturehealing we believe a construct using metal woven cable isbiomechanically preferable over a fibre wire refixation construct.VAN ROY B., NIJS S., BROOS P.: Proximal humeral nailing: 4 systemscompared. Eur. J. Trauma, 2006; 32: 122 (Abstract).Introduction: Proximal humeral fractures are endemic. Two and threepart fractures often have been treated conservatively. It nowadaysbecomes clear that an anatomical reconstruction and stable fixation ofthese fractures, allowing early active mobilization, results in betterfunctional outcome. A minimal invasive approach to the proximalhumerus avoiding the risks of adhesion formation and reducing therisk of avascular necrosis is beneficial for the patient, at least when astable fixation can be achieved. To achieve this stability was difficultusing non angular stable systems. The advent of angular stablefixation systems should solve this problem of implant loosening in theosteoporotic, metaphyseal bone. Different systems of achieving thisstability have been proposed.125