Introduction: The goal of this study is to report the clinical and radiographic results of 2 types of implants used to treat 3 and 4 parts fractures of the proximal humerus.

Patients: Sixty-three patients (64 shoulders) were reviewed in this retrospective series. Forty women and 23 men were included, the mean age was 64 ± 12 (39–86). A group of 31 patients was managed with a ‘standard’ implant, a second group of 32 patients (33 shoulders) was managed with a ‘fracture’ implant. The delay between initial trauma and the surgical procedure was less than 4 weeks (1–30 days) for all patients.

Methods: All the procedures were carried out by a senior surgeon. The patients were reviewed by an independent observer with a mean follow-up of 59 ± 38 months (12–138) for a clinical and radiographic evaluation.

Results: In the ‘standard implant’ group; 84% of the patients were satisfied or very satisfied regarding the outcome of surgery. The subjective evaluation (SSV score) was 69% (30–100%). The active anterior elevation (AAE) was 117° ± 43° (30–180°), the active external rotation (AER) was 24° ± 20° (0–60°), the active internal rotation (AIR) was up to the T12 vertebra (buttocks-T8). The mean Constant score was 60 ± 20 points (24–95). The radiographic analysis revealed a greater tuberosity that was considered migrated, not healed or lysed in 65% of cases. The acromion – implant height was ≤ 7mm in 52% of the patients. In the ‘fracture implant’ group; all the patients were satisfied or very satisfied regarding the outcome of the surgery. The SSV score was 70% (20–100%). The AAE was 132° ± 36° (45–180°), the AER was 34° ± 16° (0–60°), the AIR was up to the L3 vertebra (buttocks-T8). The mean Constant score was 66 ± 16 points (33–95). The radiographic analysis revealed a greater tuberosity that was considered migrated, not healed or lysed in 33% of cases. The acromion – implant height was ≤ 7mm in 30% of the patients. The patients with a healed greater tuberosity in an adequate position had better Constant scores: 71 points versus 54 points for those with a greater tuberosity not healed/lysed or in a bad position (p=0.03). A healed greater tuberosity in an adequate position was obtained more constantly for the patients in the ‘fracture implant’ group (p=0.02).

Conclusion: A healed greater tuberosity in an adequate position is a significant parameter influencing the outcome of hemiarthroplasty for proximal humerus fractures. A fracture designed implant allows better greater tuberosity positioning and healing.

Purpose of the study: There is no satisfactory surgical solution for symptomatic osteoarthritis of the elbow joint with preserved functional motion if arthroplasty is not indicated (age, functional demand). The same is true for resistant epicondylalgia. The joint denervation techniques applied for the wrist and proximal inter-phalangeal joints have demonstrated their efficacy. We conducted an anatomic study of elbow innervation as a preliminary step to the development of a standardized surgical procedure for complete denervation of the elbow compartment.

Material and methods: The study was conducted on 15 right and left unprepared fresh cadaver specimens. A standardized dissection method was used. The terminal branches of the brachial plexus were dissected proximally to distally under magnification, from the root of the arm to the mid third of the forearm.

Results: Innervation of the medial compartment arose: anteriorly, from one of the two capsuloperiosteal branches arising from the medial nerve; in the epitrochleo-olecraneal gutter, from capsular branches issuing from the trunk of the radial nerve at the root of the arm and running with the ulnar nerve. The innervation of the lateral compartment arose: anteriorly, from an inconstant capsular branch issuing from the musculo-cutaneous nerve arising 4 to 7 cm downstream from the joint space and running between the bones. In the other cases, this zone was innervated by a nerve branch coming from the dorsal cutaneous nerve of the forearm issuing from the radial nerve. This branch innervated the apex of the laeral epicondyle in all cases. The posterior part of the lateral compartment was constantly innervated by a branch arising from the radial nerve in the proximal part of the arm, running between the deep hed of the triceps and the vastus lateralis, giving rise of nerves innervating the joint and terminating in the body of the anconeus muscle.

Discussion: Our study enabled the description of new sources of elbow innervation not reported by Wilhelm.

Conclusion: This systematization study of elbow joint innervation is a preliminary step to the development of a complete procedure for unicompartmental lateral or medial denervation of the elbow joint. The fields of application are the treatment of symptomatic osteoarthritis of the elbow joint in patients with preserved joint motion and resistant epicondylalgia.