The block-bridge system: A new concept and surgical technique to reconstruct articular surfaces and tuberosities in complex proximal humeral fractures

Surgical treatment of complex displaced fractures of proximal humerus has changed in the last few years. Osteosynthesis has a high rate of nonunion, malunion, and avascular necrosis, and the results of hemiarthroplasty are not always functionally satisfactory. We report the results of a new technique for the reconstruction of the proximal humerus around a triangular-shaped bone block positioned inside the head and the metaphysis. The fragments are stabilized with minimal osteosynthesis by Kirschner wires, screws, or sutures. From 2001 to 2005, we treated 33 patients (20 men, 13 women) aged 34 to 74 years. The functional results were evaluated by the Constant score, with a mean follow-up of 24 months (range,12-36 months) The mean Constant score was 68 (range, 47-90). The results were excellent or good in 23 patients. The mean active anterior elevation was 160°, all were pain free, and they returned to their preoperative activities, including sports. One patient had a symptomatic avascular necrosis that was treated with a hemiarthroplasty. The results show that this new technique has good clinical results with a low percentage of complications.