Osteosynthese International 2013 – Thursday, 14 February / Injury, Int. J. Care Injured 44S2 (2013) S1–S5 S5

T2.3

Is the peg better than the screw in the locking plates preventing

penetration in proximal humeral fractures?

N. Aksu1, B. Abay1, R. Soydan1, C. Kopuz1, A.N. Kara1, Z.U. Isiklar2.1Istanbul Bilim University Florence Nightingale Hospital Ortophaedics

and Traumatology Department, 2Florence Nightingale Hospital

Ortophaedics and Traumatology Department, Istanbul, Turkey

Introduction: Surgical treatment outcome of PHiLOS and S3 plates

in the same AO type proximal humerus fracture were compared.

Materials and Methods: We evaluated the results of proximal

humerus fractures in 15 patients treated with S3 plate, with a mean

age of 64.5 (33–84) and a mean follow-up of 46.5 months (40.5–

52.5) and 15 patients with the same AO type fractures with a mean

age of 66.8 (34–87) and a mean follow up of 68.4 (50.5–88) months

between October 2005 and December 2012. Four patients in S3 plate

group and one patient in PHiLOS group had rotator cuff repairs and

we used cannulated screws for head fragments in three patients in

S3 group and two patients in PHiLOS group.

Results: We encountered postoperative complications in 4 (3

females, 1 male) patients in S3 group including three intra-

articular peg penetrations, three head collapse, and one insufficient

tubercule reductions. One patient with varus malposition had varus

displacement and peg penetration. Two valgus impacted fractures

postoperatively had peg penetrations due to head collapse at follow-

ups. In patients treatedwith PHiLOS plates, two insufficient tubercule

reductions and two impingement syndromes were observed, screw

penetration was not observed. Non of the patients had union

problems. Constant–Murley scores are 80.5 (50–100) in S3 group and

86.2 (66–100) in PHiLOS group.

Conclusion: When PHiLOS and S3 plate fixation was compared,

complication rate of S3 plate fixation was higher. Design features

acclaimed to prevent head penetration such as smooth pegs and

subchondral support was not observed in clinical application of S3

plate in this cohort of patients with the same fracture types. We

recommend cautious use of S3 plates especially in valgus impacted

fractures.

T2.4

Combined humeral head and shaft fractures – a challenging

fracture pattern. How good is the nail?

A. Dietze1, H.W. Stedtfeld1, T. Mittlmeier1, G. Gradl1. 1Chirurgische

Universitatsklinik Abteilung Fur Unfallchirurgie, Rostock, Germany

Introduction: Combined displaced humeral head and shaft fractures

are a rare fracture entity. Whereas for humeral head fractures and

humeral shaft fractures numerous treatment options are described

in the literature few recommendations are found for combined

humeral head and shaft fractures. Recently besides plate fixation,

intramedullary interlocking nailing was described for humerus

fracture entities. The aim of our study was to evaluate the shoulder

function and complication rate of locking intra-medullary nail

fixation in combined humeral head and shaft fractures.

Materials and Methods: Of the 32 consecutively enrolled patients

(between 2002 and 2004, two center study), 3were lost for follow up.

Of the remaining 29 cases the 12months follow up shoulder function

determined with the Constant–Murley score was 74±19 points.

Results: Complications were seen in 4 cases and reoperations

were necessary in 2 cases. The Targon PH long nail was used for

fracture fixation. Functional outcomes were compared and discussed

with results after conservative and operative treatment of proximal

humerus and humerus shaft fracture.

Conclusion: As a result interlocking intramedullary nailing is

considered a reliable treatment option for the instable fracture

pattern of combined humeral head and shaft fractures.

T2.5

Treatment ofmiddle third fracture of clavicle with locking plate

E. Erturer1, F. Seckin2, A. Seker2, M. Sonmez2, A. Kara2, I. Ozturk3.1Istanbul Medipol University, 2Sisli Etfal Research and Training Hospital,3Istanbul University, Turkey

Introduction: This study aims to evaluate clinical and radiologic

results of middle third clavicle fractures treated with anatomic

contoured locking plates.

Materials and Methods: Nineteen patients who were operated

between May 2009 and March 2012 for middle clavicle fracture (5

female [26.3%], 14male [73.7%],mean age: 39.2 [range; 23–58] years),

were retrospectively evaluated. Eleven patients had right, eight

patients had left clavicle fractures. Indications for surgical treatment

were displacement more than 20mm, shortening, comminuted

or displaced segmental fractures, incompliance to conservative

treatment. The mechanism of fracture were traffic accident in seven

patients, sports trauma in six patients and fall in six patients. The

precontoured anatomic lowprofile clavicle plateswith 2.7mmand/or

3.5mm locking screwswere applied anteriorly or superiorly. Patients

were evaluated radiologically and clinically with Constant score at

last visit. Mean follow up time was 28.4 (Range; 8–39) months.

Results: Complete fracture union was observed in all patients within

a mean of 9.1 (range; 8–13) weeks. Disappearance of half of the

fracture line in radiographs was accepted as complete union. Callus

formation was observed in none of the patients. There was no

infection or complications related with fixation failure. A patient

had complaints related with plate irritation and three patients had

cosmetic problems on incision. The mean Constant score was 90.12

(range; 60–100) points at last follow up control.

Conclusion: Complications such as shortening and excessive callus

formation can be seen after conservative treatment of displaced or

comminuted fractures of middle third clavicle. Anatomic contoured

low profile locking plates decrease complications and difficulties in

fixation; increase patients’ satisfaction with high union rates.