Mustafa KILIÇ, Alexander BERTH, Georges BLATTER, Uwe FUHRMANN, Katja GEBHARDT, Olaf ROTT, Peter ZENZ, Ulrich IRLENBUSCH

Anatomic and reverse shoulder prostheses in fracture sequelae of the humeral head

Amaç: Proksimal humerusun sekonder kırık protezleri genellikle sorunludur. Bu durumun en sık nedeni tüberküllerin nekrozu ve buna bağlı rotator kılıf yetmezliğidir. Bu çalışmada anatomik ve ters omuz protezlerinin farklı kullanımı ile ameliyat öncesi duruma göre daha iyi sonuçlar elde edilip edilmediği araştırılmıştır. Çalışma planı: Humerus başının kırık sekellerine bağlı sekonder omuz protezi uygulanmış olan 55 hasta izlenmiştir. Olgular›n 36's›na (Boileu kriterlerine göre tip 1 ve 2 sekelleri bulunanlar) anatomik, 19'una (tip 3 ve 4 sekelleri bulunanlar) ters protezler yerleştirilmiştir. Sonuçlar: Boileu ve Walch kriterlerine göre tip 1 ve 2 sekelleri bulunan hastaların ortalama skorları 19'dan 68'e (anatomik protez), tip 3 ve 4 sekelleri bulunan hastaların ortalama skorları ise 9'dan 47.5'e yükselmiştir (ters protez). Çıkarımlar: Sekonder kırık tedavisinde anatomik ve ters omuz protezlerinin uygun endikasyonla kullanılması ameliyat sonrası sonuçları iyileştirmektedir. Tip 1 ve 2 sekellerde anatomik protez daha iyi bir seçenektir. Deformasyonun daha ileri derecede olduğu tip 3 ve 4 sekellerde ise ters protez anatomik proteze göre belirgin olarak üstündür.

Humerus başının kırık sekellerinde anatomik ve ters omuz protezleri

Objectives: Arthroplasty for the proximal humerus problems secondary to fractures is troublesome, because of necrosis of the tubercles and the resulting insufficiency of the rotator cuff. The aim of this study was to investigate whether better results can be achieved with the differential use of anatomic and reverse shoulder prostheses, in comparison to the preoperative status. Methods: Fifty-five patients with secondary fracture prostheses due to sequelae of fractures of the humeral head were followed. Anatomic prostheses were implanted in 36 cases (fracture sequelae types 1 and 2 according to Boileau), and reversed prostheses were implanted in 19 cases (fracture sequelae types 3 and 4). Results: The mean scores of the patients improved from 19 to 68 points (anatomic prosthesis) for fracture sequelae types 1 and 2, and from 9 to 47.5 points (reverse prosthesis) for fracture sequelae types 3 and 4. Conclusion: The differential use of anatomic and reversed shoulder prostheses in secondary fracture treatment leads to an improvement in postoperative results. In fracture sequelae types 1 and 2, the anatomic prosthesis is a better choice. However, in fracture sequelae types 3 and 4 with severe deformities, the reversed prosthesis is clearly superior to the anatomic prosthesis.

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