Introduction: Adjustable shoulder prosthesis is used for complex fractures. Indications for this system are: a three-part humeral fracture in an osteoporotic bone and four-part fractures (except where the head is no longer attached at all). In case of symptomatic avascular necrosis of the humeral head, it is possible to transform the system from an osteosynthesis device to a hemi-prosthesis by removing the staple and exchanging it with the head, placed on the same morse taper of the stem. If the indication justifies a prosthesis, then the system allows for simple prosthetic head height adjustment and optimum tuberosity repair.
Materials and Methods: We present a report on 26 Bilboquet devices with an average follow-up of 25 months. The peripheral support of the humeral head is optimal in resisting varus displacement. A prospective study of 22 Bilboquet cases with an average follow-up of 34 months was conducted. Place in the therapeutic arsenal - on average for every 100 proximal humerus fractures: 20% are treated by prosthetic arthroplasty; 53% are osteosynthesised by a centromedullary nail or locking screw-plates and 27% can potentially be treated by a system with stem and humeral head staple.
Results: This system allows for rapid and controlled, stable anatomical osteosynthesis of complex fractures of the upper extremity of the humerus allowing for regular tuberosity and humeral head consolidation. The stem/sleeve placed in the humeral diaphysis shaft allows for adjustable height distraction of the fracture site to restore the anatomy of the metaphyseal - cephalic position. Consolidation was obtained in all cases. There was no secondary tilt of the head nor migration or non-union of the tuberosites.
Conclusion: This works aims to popularize this method in Bulgaria. Just Unic expands the possibilities of better and faster functional recovery.
