title: Cortical onlay strut allograft with cerclage wiring of periprosthetic fractures of the humerus without stem loosening: technique and preliminary results.
abstract: The goal of this study was to describe an internal fixation technique for periprosthetic humeral fractures using a cortical onlay strut allograft stabilized with cerclage wires and to evaluate the preliminary results of this approach. An anterolateral approach was used to direct access the fracture and to protect the radial nerve. The fracture was reduced with two forceps, under visual control. The fracture was surrounded by two hemicylinder tibial allografts, placed around the humerus with no prior reaming to create a "sarcophagus" system. The allograft was as long as possible for optimal mechanical stability, without creating impingement with the glenoid and the elbow. Final fixation of the allograft was obtained with two cerclage wires. The arm was immobilized in a simple sling. Passive then active rehabilitation was begun after 1 month. Six women, mean age 74.3 ± 10.9 years old, were included in the study between 2013 and 2015 with a mean follow-up of 10 ± 2 months. Bone union was obtained in all patients after 6 months of follow-up with no recurrent fractures.
authors.affiliation: Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
authors.forename: André
authors.initials: A
authors.lastname: Thés
authors.affiliation: Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France. klouche_shahnaz@yahoo.fr.|Ambroise Paré Hospital, 9, avenue Charles De Gaulle, Boulogne-Billancourt, 92104, France. klouche_shahnaz@yahoo.fr.
authors.forename: Shahnaz
authors.identifier: http://orcid.org/0000-0002-9591-9831
authors.initials: S
authors.lastname: Klouche
authors.affiliation: Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
authors.forename: Marine
authors.initials: M
authors.lastname: de Tienda
authors.affiliation: Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bauer
authors.affiliation: Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.|Université de Versailles Saint-Quentin-en-Yvelines, UFR des Sciences de la Santé, Versailles, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hardy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects* / Q000379:methods; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D001864:Bone Wires; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Internal fixation; Periprosthetic fractures; Sarcophagus technique; Shoulder arthroplasty