Reconstruction of the Proximal Humerus

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In spite of the obvious dimensional discrepancy between the epiphyses of the humerus and the fibula, the described procedure is indicated also in the reconstruction of the proximal humerus and provides good functional results.

In this anatomical district the osteosynthesis is accomplished by plates. In order to improve the elasticity of the implant and to prevent possible fractures, which in

Hallux Arthrodesis

Fig. 10D.3. In humeral reconstruction, the bone fixation is achieved by means of long reconstruction plates. The distal fibula is inserted into the medullary canal of the humerus. In order to improve the elasticity of the implant and to minimize the damage to the fibula, few 2,7 screws should be used to fix the plate to the transferred bone.

Fig. 10D.3. In humeral reconstruction, the bone fixation is achieved by means of long reconstruction plates. The distal fibula is inserted into the medullary canal of the humerus. In order to improve the elasticity of the implant and to minimize the damage to the fibula, few 2,7 screws should be used to fix the plate to the transferred bone.

our early cases occurred at the level of the most proximal screw, it is recommended the use of long reconstruction plates which should be fixed by few screws (Fig. 10D.3). The resulting implant is much less rigid than that achievable with a traditional compression plate and the distribution of the mechanical stresses is more homogeneous. When possible, an intramedullary insertion of the fibula in the distal stump of the humerus is highly recommended. In that case, an oversize distal periosteal cuff should be preserved in the fibula and used to overlap the osteotomy site in order to facilitate the bone fusion.

Fig. 10D.4. The stability of the shoulder depends on appropriate soft tissue reconstruction. Note the strip of biceps femoris tendon which is usually anchored to the glenoid in order to improve the stability of the joint. The rotator cuff is sutured contouring the fibular epiphysis.

The soft tissue repair around the transferred epiphysis is complicated by the potential danger for the epiphyseal vascular network related to direct reinsertion on the bone of the rotator cuff and deltoid. For this reason the muscles are just sutured around the fibular head and the strip of biceps femoris tendon is anchored to the glenoid achieving acceptable stability (Fig. 10D.4). In some cases, however, a proximal displacement of the physis does occur due to anatomical discrepancy and insufficient stabilization.

In humeral reconstruction the suggested recipient artery is the deep humeral artery. When it is not available or too small in diameter, an end to side anastomosis with the brachial artery is preferred.

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