[Incidence of humeral head osteonecrosis after fracture of the superior end of the humerus].
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Progress in preoperative chemotherapy and radiation therapy, both intra- and postoperative, has in time allowed for an increase in indications for shoulder implant surgery in malignant tumors, thus drastically reducing the number of amputations. The use of prostheses, particularly those of the more recent generation, respond to the needs to overcome the limits of loss of movement, as long as good anatomical reconstruction of the soft tissues, the premise for good functional and cosmetic recovery, is also possible. The current tendency is that of using modular shoulder prostheses that provide a wide variety of sizes. This type of prosthesis has surpassed custom made prostheses in terms of simplicity, adaptability and economy. The use of cementation in stabilization of the intramedullary stem has made them more stable even in the long term, allowing for early rehabilitation. The main problem in reconstruction with a prosthesis is the quantity of residual muscular tissue (deltoideus, extrarotators) and the stabilization system of the same to the prosthesis in order to avoid dislocation, which constitutes the main complication. It is the purpose of this study to present the clinical and functional results obtained in 23 implants carried out for primary malignant neoformation of the upper limb. The implants studied were of three types (custom made, modular in Cr-Co-Mb and Ti-Al-Va). The results reported show how a shoulder prosthesis can obtain good functional results, particularly when a part of the activator muscles of the shoulder such as the deltoideus and the extrarotators is preserved. When the contrary is true, the results obtained are modest because the prosthesis acts as a simple spacer.
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Were reviewed 200 fractures of humeral diaphysis, two cases have been excluded because they were incomplete; 175 patients out of 200 have been reexamined a long time after; 23 have not been reexamined but held a sufficient follow up. Most of the transversal fracture were met among young adults (56 per 100 traffic accidents). The intraosseous vascularisation was studied elucidating partly the greatest frequency of pseudarthrosis in the part 1/3 middle-1/3 inferior especially after exaggerated periostal elevation. Among 107 cases treated by hanging cast were noted 4 pseudarthrosis, 12 shoulder's stiffnesses. Traction or external fixation were rarely useful (comminuted fractures, burns). Surgical procedures were rarely necessary because this type of fracture usually united with good result after conservative treatment. The outcomes of 40 osteosynthesis were examined and non-unions were noted. Vascular (4 out of 200) and nervous (29 out of 200) complications were also noted.
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