Surgery treatment intraarticular fractures of proximal humerus

Česká verzia

Authors: Radek Pikula ¹; Daniel Ira ¹; Milan Krtička ¹; Michal Kýr ²; Michal Mašek ¹
Authors place of work: Tramacentrum FN Brno ¹; Klinika dětské onkologie LF MU a FN Brno ²
Published in the journal: Úraz chir. 21., 2013, č.3

Summary

INTRODUCTION:
Intraarticular fracture of the proximal humerus is considered a severe trauma diagnosis. Surgical treatment is still subject to extensive discussions and numerous articles .

GOAL:
The aim of this study is to compare the functional results of operative treatment methods and conservative treatment with respect to the age of the patient. In our study, we asked three questions. 1. Are fractures C 1.1, C 1.2, C 1.3, C 2.1 indicated for conservative therapy? 2. Are fractures C 2.2, C 2.3, C 3.1 C 3.2 C 3.3 in patients under the age of 65 indicated for osteosynthesis by locking compression plate? 3. Are fractures C 2.2, C 2.3, C 3.1 C 3.2 C 3.3 in patients over 65 years of age indicated for hemiarthroplasty implantation (CKP)?

METHODS:
In our study we included 159 patients with intra-articular fractures of the proximal humerus treated in our department from 2009 to 2013. Majority of patients underwent CT examination and were classified according to the AO (Arbeitsgemeinschaft für osteosynthesefragen) classification [13]. Based on the classification of fractures, biological age, comorbidities, local state and requirements for patient mobility and function, patients were indicated for conservative treatment or surgical procedure and the respective type of osteosynthesis. Pa-tients were then followed up for 1 year after injury, underwent X-ray controls (6 weeks, 3 months and 1 year after injury), and CSS (Constant-Murley Shoulder Score) [5] was evaluated 1 year after injury.

RESULTS:
According to our study, surgical treatment in C 1 and C 2.1 fractures has significantly better results than conservative treatment. Only younger patients had significantly better functional results regardless of the treatment procedure.

In C 2.
2, 2.3 and C 3 fractures we did not prove significantly better functional outcome in surgical treatment by PHILOS (Proximal Humeral Internal Locking System) plate against hemiartroplasty in patients under 65 years of age. And also we did not prove in C 2.2, 2.3 and C 3 fractures better functional outcome in surgical treatment by hemiarthroplasty against PHILOS plate in patients over 65 years of age.

CONCLUSION:
The results of our study confirm the complexity and ambiguity of procedures for treatment of intra-articular fractures of the proximal humerus.

Key words:
proximal humerus fractures, hemiarthoplasty (CKP), PHILOS.

Zdroje

1. BARTONÍČEK, J., DŽUPA, V., FRIČ, V. et al. Epidemiology and economic implications of fractures of proximal femur, proximal humerus, distal radius and fracture-dislocation of ankle. Rozhl Chir. 2008, 87, 213–219.

2. BOILEAU, P., KRISHNAN, S.G., TINSI, L., et al. Tuberosity malposition and migration: reasons for poor outcome after hemiartroplasty for displaced fractures of the proximal humerus. J Shoulder Elboe Surg. 2002, 11, 402–412.

3. BRORSON, S., RASMUSSEN, J.V., FRICH, L.H. et al. Benefits and harms of locking plate osteosynthesis in intraarticular (OTA Type C) fractures of the proximal humerus: a systematic review. Injury. 2012, 43, 999–1005.

4. CAI, M., TAO, K., YANG, C., LI, S. Internal fixation versus shoulder hemiarthroplasty for displaced 4-part proximal humeral fractures in elderly patients. Orthopedics. 2012, 35, 1340–1346.

5. CONSTANT, C.R., MURLEY, A.H. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987, 214, 160–164.

6. COURTBROWN, C.M., CATTERMOLE, H., MCQUEEN, M.M., Impacted valgus fractures B1.1 of the proximal humerus. The results of nonoperative treatment. J Bone Joint Surg Br. 2002, 84, 504–508.

7. COURTBROWN, C.M., GARG, A., MCQUEEN, M.M. The translated two-part fractures of the proximal humerus. Epidemiology and outcome in the older patient. J Bone Joint Surg Br. 2001, 83, 799–804.

8. COURTBROWN, C.M., MCQUEEN, M.M. The impacted varus A 2.2 proximal humerus fractures: prediction of outcome and results of nonoperative treatment in 99 patinets. Acta Orthop Scand. 2004, 75, 736–740.

9. FAN, Y., WANG, S., LUO, Y. Effectiveness comparison of operative and non-operative treatment for complex proximal humeral fractures in elderly patiens. Zhonqquo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012, 26, 1029–1032.

10. GAEBLER, C., MCQUEEN, M.M., COURTBROWN, C.M. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand. 2003, 74, 580–585.

11. GRAWE, B., LE, T., LEE, T., WYRICK, J. Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus: Does Age Really Matter? Geriatr Orthop Surg Rehabil. 2012, 3, 27–32.

12. HERTEL, R. Fractures of the proximal humerus in osteoporotic bone. Osteoporosis In. 2005, 16, S65–72.

13. JAEGER, M., LEUNG, F., LI, W. AO Surgery Reference. Müller AO Classification of Fractures – Proximal Humerus. https://www2.aofoundation.org/wps/portal/surgery?show Page =diagnosis&bone=Humerus&segment=Proximal. 2007.

14. JONES, K.J., DINES, D.M., GULLOTA, L. et al. Management of proximal humerus fractures utilizing reverse total shoulder arthroplasty. Curr Rev Musculoskelet Med. 2013, 6, 63–70.

15. KOS, J. Arterie pouzdra kloubu ramenního a loketního v obraze roentgenovém. Rozhl Chir. 1951, 30, 3–11.

16. KOVAL, K.J., GALLAGHER, M.A., MARSICANO, J.G., et al. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997, 79A, 203–207.

17. KRALINGER, F., SCHWAIGER, R., WAMBACHER, M., et al. Outcome after primary hemiartroplasty for fractures of the head of the humerus. A retrospective multicenter study of 167 patients. J Bone Joint Surg Br. 2004, 86B, 217–219.

18. KŘIVOHLÁVEK, M., LUKÁŠ, S., TALLER, J. et al. Použití úhlově stabilních implantátů při ošetření zlomenin proximálního humeru – prospektivní studie. Acta Chir Orthop Traum Čech. 2008, 75, 212–220.

19. LUKÁČ, L., PLEVA, L., MADEJA, R. Možnosti využití reverzní TEP ramenního kloubu v úrazové chirurgii. Úraz chir. 2007, 15, 114–118.

20. PLECKO, M., KRAUS, A. Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Operat Orthop Traumatol. 2005, 17, 25–50.

21. ROBINSON, C.M., PAGE, R.S., HILL, R.M., et al. Primary hemiartroplasty for treatment of proximal humerus fractures. J Bone Joint Surg Am. 2003, 85A, 1215–1223.

22. ROCKWOOD, C.A., BUCHOLZ, R.W., COURTBROWN, C. et al. Rockwood and Green‘s Fractures in Adults. 2009. Lippincott Williams & Wilkins. 2296 s.

23. SOSNA, A., POKORNÝ, D., VAVŘÍK, P. et al. Endoprotéza ramenního kloubu v traumatických indikacích – operační technika. Acta Chir Orthop Traumatol Čech. 2004, 71, 265–271.

24. SPROSS, C., PLATZ, A., ERSCHBAMER, M. et al. Surgical treatment of Neer Group VI proximal humeral fractures: retrospective comparison of PHILOS and hemiartroplasty. Clin Orthop Relat Res. 2012, 470, 2035–2042.

25. TALLER, S., KŘIVOHLÁVEK, M., LUKÁŠ, R. et al. Hemiartroplastika v léčbě zlomenin proximálního humeru. Acta Chir Orthop Traumatol Čech. 2007, 74, 262–267.

26. YTO, K. Nonoperative treatment of comminuted fractures of the proximal humerus in enderly patients. Injury. 1998, 29, 349–352.

Štítky

Surgery Traumatology Trauma surgery

Článek Humerus head osteonecrosis in surgical treatment intraarticular fractures of proximal humerus by PHILOS plate

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Článek Micronail Insertion into Cadaver Distal Radius: A Study of Insertion Location, Rotation and Screw Articular and Cortical Penetration

Článok vyšiel v časopise

Trauma Surgery

2013 Číslo 3

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