DAVUT KESKİN, Naci EZİRMİK, Orhan KARSAN, Ramazan OKUTAN

Erişkin proksimal humerus kırıkları ve cerrahi tedavi sonuçları

Amaç: Bu çalışmada değişik cerrahi yöntemlerle tedavi edilen deplase humerus proksimal kırıklarının sonuçları incelendi. Çalışma planı: Proksimal humerus kırığı nedeniyle kapalı redüksiyon ve perkütan Kirschner teli tesbiti veya açık redüksiyon ve internal tesbit yöntemi ile tedavi edilen 30 hasta (18 erkek, 12 kadın; ort. yaş 46.7; dağılım 20-80) çalışmaya alındı. Kırıkların sınıflandırılması ve radyolojik değerlendirilmesi Neer'in tarif ettiği şekilde yapıldı. Sekiz olguda (%26.7) iki parçalı, 16'sında (%53.3) üç parçalı, altısında (%20) dört parçalı kırık saptandı. Ortalama takip süresi 1.2 yıl (dağılım 5 ay-7 yıl) idi. Sonuçlar: iki parçalı kırığı olan olguların yedisinde (%87.5), üç parçalı kırığı olanların 12'sinde (%75), dört parçalı kırığı olanların ikisinde (%33.3) başarılı sonuç elde edildi. Başarısız sonuç alınan olgularda gözlenen en önemli nedenler ağrı ve hareket kısıtlılığı idi. Dört parçalı kırığı olan olguların birinde aseptik nekroz, birinde de kırığın kaynamamasına bağlı olarak plak kırılması oluştu. Çıkarımlar: Gençlerde konservatif olarak tedavi edilemeyen iki parçalı kırıklarda, eğer mümkünse kapalı redüksiyon ve kırığın perkütan tel ya da vidalarla tesbitinin, mümkün değilse tüm parçalı kırıklarda açık redüksiyon ve internal tesbitin uygun olduğu; yaşlılarda ise, iki ve üç parçalı kırıkların açık redüksiyon ve internal tesbitle tedavi edilebileceği, dört parçalı kırıklarda ise primer hemiartroplasti uygulamasının düşünülebileceği sonucuna varıldı.

Anahtar Kelimeler:

Humerus, Omuz eklemi, Omuz kırıkları, Çıkıklar, Kırık tespiti, internal, Humerus kırıkları

Proximal humeral fractures in adults and the results of surgical treatment

Objectives: We evaluated the results of different operative methods used in the treatment of displaced proximal humeral fractures. Methods: Thirty patients (18 males, 12 females; mean age 46.7 years; range 20 to 80 years) with proximal humeral fractures were treated by closed reduction and percutaneous fixation with Kirschner wires or open reduction and internal fixation. The fractures were classified and the radiological results were evaluated according to the Neer criteria. The number of fracture fragments was two in eight patents (26.7%), three in 16 patients (53.3%), and four in six patients (20%). The mean follow-up was 1.2 years (range 5 months to 7 years). Results: The results were satisfactory in seven patients (87.5%) with two-part fractures, 12 patients (75%) with three-part fractures, and two patients (33.3%) with four-part fractures. The most common causes in patients with unsuccessful results were pain and limitation of movement. Two patients with four-part fractures developed aseptic necrosis and plate breakage secondary to nonunion, respectively. Conclusion: In our opinion, where conservative treatment is not indicated, the most appropriate treatment for displaced proximal humeral fractures at younger ages is closed reduction and fixation with percutaneous wires or screws, and if this is not possible, open reduction and internal fixation. However, in elderly patients, open reduction and internal fixation for two- or three-part fractures, and primary hemiarthroplasty for four-part fractures seem to be preferable

Keywords:

Humerus, Shoulder Joint, Shoulder Fractures, Dislocations, Fracture Fixation, Internal, Humeral Fractures,

PDF

___

1.Bigliani LU, Flatow EL, Pollock RG. Fractures of the proximal humerus. In: Rockwood CA, Green DP, Bucholz RW, editors. Fractures in adults. 4th ed. Philadelphia: Lipincott- Raven; 1996, p. 1055-107.
2. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg [Am] 1970;52:1077-89.
3. Brooks CH, Revell WJ, Heatley FW. Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study. J Bone Joint Surg [Br] 1993;75:132-6.
4. Hawkins RJ, Angelo RL. Displaced proximal humeral fractures. Selecting treatment, avoiding pitfalls. Orthop Clin North Am 1987;18:421-31.
5. Lin J, Hou SM, Hang YS. Locked nailing for displaced surgical neck fractures of the humerus. J Trauma 1998;45:1051-7.
6. Moda SK, Chadha NS, Sangwan SS, Khurana DK, Dahiya AS, Siwach RC. Open reduction and fixation of proximal humeral fractures and fracture-dislocations. J Bone Joint Surg [Br] 1990;72:1050-2.
7. Norris TR, Green A. Proximal humerus fractures and fracturedislocations. In: Browner BD, Jupiter JB, Levin AM, Trafton PG, editors. Skeletal trauma. 2nd ed. Vol. 2, Philadelphia: W.B. Saunders; 1998, p. 1570-656.
8. Paavolainen P, Bjorkenheim JM, Slatis P, Paukku P. Operative treatment of severe proximal humeral fractures. Acta Orthop Scand 1983;54:374-9.
9. Mills HJ, Horne G. Fractures of the proximal humerus in adults. J Trauma 1985;25:801-5.
10. Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg [Am] 1970;52:1090-103.
11. Zyto K, Ahrengart L, Sperber A, Tornkvist H. Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg [Br] 1997;79:412-7.
12. Chen CY, Chao EK, Tu YK, Ueng SW, Shih CH. Closed management and percutaneous fixation of unstable proximal humerus fractures. J Trauma 1998;45:1039-45.
13. Svend-Hansen H. Displaced proximal humeral fractures. A review of 49 patients. Acta Orthop Scand 1974;45:359-64.
14. Brooks CH, Carvell JE. External fixation for fracture-dislocations of the proximal humerus. J Bone Joint Surg [Br]1989;71:864-5.
15. Kristiansen B, Christensen SW. Plate fixation of proximal humeral fractures. Acta Orthop Scand 1986;57:320-3.
16. Leyshon RL. Closed treatment of fractures of the proximal humerus. Acta Orthop Scand 1984;55:48-51.
17.Young TB, Wallace WA. Conservative treatment of fractures and fracture-dislocations of the upper end of the humerus. J Bone Joint Surg [Br] 1985;67:373-7.
18. Jaberg H, Warner JJ, Jakob RP. Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg [Am] 1992;74:508-15.
19. Resch H, Povacz P, Frohlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg [Br] 1997;79:295-300.
20. Aktuğlu K, Önçağ H. Humerus üst uç ve cisim kırıklarında kilitli Seidel çivisi uygulamalarımız. Acta Orthop Traumatol Turc 1994;28:171-3.
21. Gürbüz H, Sekhavat H, Demiral H. Omuz protezi uygulamaları mız. Acta Orthop Traumatol Turc 1998;32:100-2.
22. Hartsock LA, Estes WJ, Murray CA, Friedman RJ. Shoulder hemiarthroplasty for proximal humeral fractures. Orthop Clin North Am 1998;29:467-75.
23. Moeckel BH, Dines DM, Warren RF, Altchek DW. Modular hemiarthroplasty for fractures of the proximal part of the humerus. J Bone Joint Surg [Am] 1992;74:884-9.
24.Wretenberg P, Ekelund A. Acute hemiarthroplasty after proximal humerus fracture in old patients. A retrospective evaluation of 18 patients followed for 2-7 years. Acta Orthop Scand 1997;68:121-3.
25. Movin T, Sjoden GO, Ahrengart L. Poor function after shoulder replacement in fracture patients. A retrospective evaluation of 29 patients followed for 2-12 years. Acta Orthop Scand 1998;69:392-6.
26. Koval KJ, Blair B, Takei R, Kummer FJ, Zuckerman JD. Surgical neck fractures of the proximal humerus: a laboratory evaluation of ten fixation techniques. J Trauma 1996;40:778-83.