Shoulder fracture

Fracture in caput Valga on the humeral upper extremity.

Image n° 1: pre-operative (02 - 19 - 1999)

Note: The anatomical humeral head is 90°, rotated laterally and lies horizontally. There is a severe cancellous bone compression. The great tuberosity is broken and a large fragment is pushed laterally. After realignment of the humeral head, the bone loss must be filled by a bone graft. In this case, a large piece of natural coral (white).

Image n° 2: post-operative (02 - 21 - 1999)

The humeral cephalic head is rebuilt vertically. A large piece of natural coral is placed in the bone defect. The great tuberosity is fixed in proper position.

Image n° 3: healing (09 - 08 - 1999)

Note: Fracture healing. Partial resorption of the coral graft. Remineralization of the humeral head. This phenomenon is due to the biomaterial resorption.

Fracture of the collar bone

Atrophic non-union of the left collar bone: car accident

Image n° 1: pre-operative (08 - 31 - 2000)

Note the large gap between the two fragments of the collar bone.

Image n° 2: four months after surgery (02 - 21 - 2000)

A large amount of bone substitute (granules of natural coral) spreads along the collar bone. After realignment, the bone's fracture is firmly fixed with a strong metallic plate.

Image n° 3: the fracture is healed (03 - 07 - 2001)

Natural coral is resorbed. A homogeneous new-bone callus is now formed. Note the quality of the new-formed bone.

Atrophic non-union of the right collar bone

Clinical story:

Y.F. is born in 1967. He is a professional teacher and tennis player. He is 15/20. He had a tongue's cancer which was treated locally. A bilateral removal of his neck's lymph node was performed, followed by radiotherapy (50 Gy on both cervical and collar fields).

He had a car accident in 1999 and breaks his right collar bone. He was treated orthopaedically. By times, no healing occurred.

He could not play tennis anymore and his right arm became weaker. It lost two centimetres in diameter.

No surgeons wanted to operate for two reasons – they claim. The skin was atrophic due to the irradiation and they were afraid of a possible necrotic bone underneath. The man was hopeless.

We had many operative possibilities to treat this case. We had a lot of discussion with the patient and his family and finally, we decided to remove the necrotic bone, to fix the fracture with a metallic plate and set a biomaterial graft.

We made an extemporaneous histological examination of the necrotic bone which reveals that « no signs of radiotherapic necrosis » was seen. It was confirmed three weeks later by a regular histological examination of bone samples.

Image n° 1: Pre-operative X-rays

Eight months after the accident, note the rounded shape of both bone extremities in the fracture site.

Image n° 2: Bone healing

Note the perfect healing of the collar bone with a nice reconstruction of the shaft and the homogeneous bone density.

Image n° 3: Picture of both shoulders before and after surgery.

The right shoulder is anatomic. The collar girdle is symmetrical. The skin is not inflammatory and both deltoids are identical.

Clinical follow-up:

November 2005. No pain, no rehabilitation problems. YF returned to sport. He teaches and plays tennis. He is again 15.

Conclusion:

The clinical follow-up shows the good motor functions and recovery of all joints. For all of them, after more than eight years, there is no modification of the fracture site. The bone healing remains stable.

Upper Limb pathology: Arm