The Bilboquet Device for Fractures of the Proximal Humerus in the Elderly

We describe a novel internal fixation device, and report on 61 patients (mean age: 76.8 years) whose proximal humeral fractures were managed with this technique. The two-part titanium implant consists of a circular staple impacted into the humeral head cancellous bone, and a spigoted diaphyseal stem that inserts into the staple "cup". Of the 61 cases reviewed, 10 had two-part fractures, 27 had three-part, and 24 had four-part fractures. In the ten two-part fracture patients, mean active forward elevation was 120 degrees. The results were: 6 excellent, 2 good, and 2 fair. In the 27 three-part fracture patients, mean active forward elevation was 120 degrees. The results were: 13 excellent, 9 good, and 5 fair. In the 24 four-part fracture patients, mean active forward elevation was 94 degrees; there were 3 excellent, 8 good, 8 fair, and 5 poor results. There were 13 cases of avascular necrosis, and two cases of tuberosity nonunion. Only three cases needed conversion to hemiarthroplasty. This technique should simplify the surgery of these fractures in the elderly, and reduce the need for arthroplasty.