Surgical versus non-surgical treatment for 3- and 4-part proximal humerus fractures
Authors:
M. Kilian 1; R. Zamborský 2; I. Chandoga 1; M. Budaj 3; S. Vajczikova 1
Authors place of work:
II. Ortopedicko-traumatologická klinika, UN sv. Cyrila a Metoda a Univerzita Komenského v Bratislave
prednosta: doc. MUDr. S. Vajcziková, PhD
1; Klinika úrazovej chirurgie, UN L. Dérera a Univerzita Komenského a Slovenská Zdravotnícka Univerzita v Bratislave
prednosta: prof. MUDr. P. Šimko, CSc
2; Oddelenie centrálneho príjmu, Nemocnica sv. Cyrila a Metoda a Univerzita Komenského v Bratislave
primár: MUDr. D. Holas
3
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 2, s. 60-68.
Category:
Original articles
Summary
Introduction:
Proximal humerus fractures account for about 4−5% of all fractures. Treatment of 3- and 4-part fractures is difficult, and the optimal treatment option remains controversial. The aim of the study was to compare surgical and non-surgical treatments of 3- and 4-part fractures of the proximal humerus in adults.
Method:
A prospective study of surgical and non-surgical treatments of 3- and 4-part fractures of the proximal humerus was conducted at the 2nd Department of Orthopedics and Traumatology, University Hospital Bratislava, from September 2010 until September 2013. Patients included in the study were compliant adults patients with 3- and 4-part proximal humerus fractures Neer type IV, V and VI. Twenty patients were treated surgically. The group included 13 women (65%) and 7 men (35%). Mean age was 60.9±7.67 (52–80) years. Angle-stable plates (Philos, Synthes) and intramedullary nails (Multilock, Synthes) were used.
The non-surgical group included 19 patients, consisting of 12 (63.2%) women and 7 (36.8%) men. Mean age of both sexes was 66.3±9.5 (52−88) years. Gilchrist bandage was applied for the maximum of 3 weeks. All patients were evaluated at 12 months from treatment using the Constant-Murley scoring system and the Oxford Shoulder Score. Treatment complications were evaluated as a secondary step.
Results:
The mean individual relative Constant-Murley score was 57.8±23.5% (11−88%) in the surgical group. The mean Oxford Shoulder score was 34.8±10.6 (10−46) points. Complications were recorded in 12 patients (60%). In the non-surgical group, the mean individual relative Constant-Murley score at 12 months from injury was 60.9±20.9% (16−90%). The mean Oxford Shoulder score was 36.1±8.9 (15−48) points. Complications were recorded in 4 patients (21.1%).
Conclusions:
In this study, surgical treatment patients with displaced 3- and 4-part proximal humerus fractures, mostly treated by angle-stable plates, showed a number of complications. Poor functional results of the surgical group were comparable to those of the non-surgical group. The indication for surgery, patient selection, type of surgery, surgical experience and subsequent rehabilitation should be carefully assessed for better results.
Key words:
proximal humerus fracture − surgical treatment − non-surgical treatment − 3- and 4-part fractures
Zdroje
1. Kristiansen B. Treatment of displaced fractures of the proximal humerus: transcutaneous reduction and Hoffmann‘s external fixation. Injury 1989;195:20.
2. Horak J, Nilsson BE. Epidemiology of fracture of the upper end of the humerus. Clin Orthop Relat Res 1975;112:250−3.
3. Court-Brown CM, Garg A, Mcqueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001;72:365−71.
4. Palvanen M, Kannus P, Niemi S, et al. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 2006;442:87−92.
5. Gaebler C, Mcqueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand 2003;74:580−5.
6. Sommer C, Gautier E, Müller M, et al. First clinical results of the Locking Compression Plate (LCP). Injury 2003;34:43−54.
7. Perren SM, Linke K, Schwieger D, et al. Aspects of internal fixation of fractures in porotic bone. Principles, technologies and procedures using locked plate screws. Acta Chir Orthop Traum Cech 2005;72:89−97.
8. Zyto K. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury 1998;29:349−52.
9. Fialka C, Oberleitner G, Stampfl P, et al. Modification of the Constant-Murley shoulder score-introduction of the individual relative Constant score Individual shoulder assessment. Injury 2005;36:1159−65.
10. Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg Br 2007;89:1206−9.
11. Křivohlávek M, Lukás R, Taller S, et al. Use of angle-stable implants for proximal humeral fractures: prospective study. Acta Chir Orthop Traum Cech 2008;75:212−20.
12. Kloub M, Holub K, Polakova S. Nailing of three- and four-part fractures of the humeral head - long-term results. Injury 2014; 45:S29−37.
13. Tauber M, Hirzinger C, Hoffelner T, et al. Midterm outcome and complications after minimally invasive treatment of displaced proximal humeral fractures in patients younger than 70 years using the Humerusblock. Injury 2015; 46:1914−20.
14. Šmejkal K, Lochman P, Dědek T, et al. Operační léčba zlomenin proximálního humeru. Acta Chir Orthop Traum Cech 2011;78: 321−7.
15. Iacobellis C, Fountzoulas K, Aldegheri R. Plating of proximal fracture of the humerus: a study of 30 cases. Musculoskelet Surg 2011;95:43–S48.
16. Piątkowski K, Kwiatkowski K, Piekarczyk P, et al. Outcome of comminuted proximal humerus fracture treatment with locking compression plate. Pol Orthop Trauma 2013;78:239−46.
17. Hirschmann MT, Fallegger B, Amsler F, et al. Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma 2011;25:286−93.
18. Chowdary U, Prasad H, Subramanyam PK. Outcome of locking compression plating for proximal humeral fractures: a prospective study. Journal of Orthop Surg 2014;22:4−8.
19. Acklin Y, Stoffel K, Sommer C. A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures. Injury Int J Care Injured 2013;44:456–60.
20. Jia Z, Li W, Qin Y, Li H, et al. Operative versus nonoperative treatment for complex proximal humeral fractures: a meta-analysis of randomized controlled trials. Orthopedics 2014;37:543−51.
21. Rangan A, Handoll H, Brealey S, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA 2015;313:1037−47.
22. Bernstein J, Adler LM, Blank JE, et al. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg [Am] 1996;78-A:1371−5.
23. Sjödén GO, Movin T, Aspelin P, et al. 3D-radiographic analysis does not improve the Neer and AO classifications of proximal humeral fractures. Acta Orthop Scand 1999;70:325−8.
24. Brorson S, Bagger J, Sylvest A, et al. Improved interobserver variation after training of doctors in the Neer system. J Bone Joint Surg [Br] 2002;84-B:950−4.
25. Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus: A retrospective analysis of 82 cases treated with the Philos locking plate. Injury 2014;45:43−8.
26. Fjalestad T, Hole MØ, Hovden IAH, et al. Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: A randomized controlled trial. J Orthop Trauma 2012;26:98−106.
27. Agudelo J, Schürmann M, Stahel P, et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma 2007;21:676−81.
28. Olsson C, Nordquist A, Petersson CJ. Long-term outcome of a proximal humerus fracture predicted after 1 year. A 13-year prospective population-based followup study of 47 patients. Acta Ortop Scand 2005;76:397−402.
29. Cordasco FA, Bigliani LU. Complications of proximal humerus fractures. Technol Orthopead 1997;12:42–50.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2016 Číslo 2
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Complications of pancreato-duodenectomy
- Surgical versus non-surgical treatment for 3- and 4-part proximal humerus fractures
- Diagnosis and treatment of billiary ileus
- Total duodenopancreatectomy for renal cell carcinoma metastases – case report