Surgical treatment of fractures of the humerus and the biological aspects of osteosynthesis

I.H. Bets


Technologies of external fixation using plates and screws designed by AO, in the last decade gained deserved recognition and popularity worldwide. These techniques are constantly in the dyna-mics, the main trend of which — to reduce surgical injury and a negative impact of implant on the regenerative capabilities of the damaged bone. This is always given the focus in the new strategic concept of AO development in general, according to which the ideas were implemented on the application of internal plates with limited contact, the use of crews with angular stability, technologie of subfascial osteosynthesis. Combined with low-impact surgical technique (the use of rational surgical approaches, special tools and intraoperative monitoring by means of electro-optical converter), it makes it possible to significantly reduce the need for devitalization of bone fragments, but, of course, does not solve the problem fundamentally: technologically traumatic surgery cannot be performed atraumatically. Considering the above trends of external osteosynthesis somewhat abstracted, you can easily conclude that in the present form, it is actually an internal extrafocal unilateral fixation. On the example of surgical treatment of humeral fractures, we consider the result of inconsistencies between surgical injuries and the requirements of the biological fixation. In our opinion, the shoulder is the most convenient and adequate for this segment since humeral fractures of any location may have indications for internal osteosynthesis; shoulder segment uncharacteristic of negative features of blood flow (as opposed to the proximal femur, distal tibia) that influence treatment strategy; in the absence of body weight load, it is easier to perform the recommended functional mode. The purpose — to clarify the scientific data on the priority of biological fixation requirements when differentiating indications for the use of methods for treating fractures of the humerus; on clinical examples of surgical treatment for humeral fractures to consider the problems associated with bone devitalization during osteosynthesis, with subsequent analysis of features of surgical technologies that meet the requirements of biological fixation. This analysis shows that one should always remember the fragile balance between the ideal repositioning of bone fragments and the creation of a stable “fixator — segment” system and the severity of surgical trauma. In case of a disturbance of this equilibrium, a delayed union or the absence of union leads to the destruction of the fixators. Not downplaying the grandiose achievements of AO, differentiation of indications for fracture treatment choice should be given attention, focusing not only on the possibility of anatomical reposition and fixation, but primarily on meeting the requirements of the chosen methods for biological osteosynthesis.


open and closed humeral fractures; the biological basis of osteosynthesis; external fixation; extrafocal osteosynthesis


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