Mais pourquoi une « autre » prothèse d'épaule Le ... - fx solutions
Mais pourquoi une « autre » prothèse d'épaule Le ... - fx solutions
Mais pourquoi une « autre » prothèse d'épaule Le ... - fx solutions
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Why a new Reversed Prosthesis ?<br />
Is it possible to do better in case of fracture ?<br />
… ?<br />
Humelock project<br />
T Lascar, JY Hery,<br />
JM Daudet,<br />
D Heraud, JJ Martin<br />
L. Obert
Humelock Reversed Project<br />
In superior glenoid wear … is it possible to decrease<br />
complications ?<br />
In fracture … is it possible to achieve best <strong>«</strong> function <strong>»</strong> ?
Superior Glenoid Wear & Reversed<br />
What did we learn ?
Superior Glenoid Wear & Reversed<br />
and … infection<br />
How to prevent ... ?
Superior Glenoid Wear & Reversed and<br />
… loosening<br />
At Glenoid level<br />
Anatomy of glenoid bone : 12 mm<br />
The smallest Ø = 24 mm<br />
Central stem + polyaxial locked screws
Superior Glenoid Wear & Reversed and<br />
… loosening<br />
At humerus level<br />
Monobloc<br />
Cemented or locked …
Respect of bone stock<br />
Reaming<br />
Ø08 : épiphysis 32<br />
Ø10 : épiphysis 36<br />
Ø12 : épiphysis 40
Respect of bone stock<br />
Metaphyseal reamer<br />
Control of retroversion<br />
Epiphyseal reamer
Superior Glenoid Wear & Reversed and<br />
… Notch<br />
Lateralization :<br />
In the prosthesis : Valenti<br />
In the <strong>«</strong> bone <strong>»</strong> : Boileau<br />
Tilt : 10°<br />
Low position …<br />
<strong>«</strong> New <strong>»</strong> Angle<br />
145°
Superior Glenoid Wear & Reversed and<br />
… Notch
Superior Glenoid wear & Reversed and<br />
… Notch
Superior Glenoid Wear & Reversed and<br />
… Notch<br />
gleno<br />
metaphyseal angle
Fracture & Reversed<br />
After 60 yo & 4 part fracture<br />
<strong>«</strong> My Goal <strong>»</strong> : more than 100° & Rotation 20°<br />
Fixation or Hemi ?<br />
After 70 yo & 4 part<br />
<strong>«</strong> My Goal <strong>»</strong> : <strong>«</strong> do what you want and what you can <strong>»</strong><br />
Hemi or Reversed ?
Fracture & Reversed<br />
Post operative Evolution more predictible<br />
Same results than in degenerative indication …?<br />
After 70 yo …<br />
Tuberosities reinsertion !
Fracture & Reversed<br />
What did we learn ?
Fracture & Reversed and … function<br />
Best function : humerus non shortened !<br />
Tension of deltoid …
Height of the implant<br />
Pectoralis major !<br />
Chef claviculaire<br />
Chef sternal<br />
Murachowsky J et al. JSES 06<br />
Torrens C et al. JSES 08<br />
Hasan SA et al. Orthopedics 09
137 CT SCAN<br />
Male / Female<br />
D Pectoral M-apex & Pectoral M-trochiter<br />
> 7 mm<br />
5,7 cm<br />
(DS : 10,317mm)<br />
2,8 cm<br />
(DS :<br />
9,029mm)<br />
6,7 cm<br />
(DS : 9,988mm),<br />
3,4 cm<br />
(DS : 9,697mm)
Fracture & Reversed and … function<br />
Best function : Tuberosities reinserted
Female 82 yo<br />
fracture CT2
Difficult to understand
Head & Tuberosities
Biceps helps you<br />
trochin<br />
Lg biceps<br />
trochiter<br />
diaphyse
The glenoid
Do not shorten the humerus<br />
Stem higher than you believe<br />
Superior limit of PM
OMS with graft
… and suture
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