Yusuf ÖZTÜRKMEN, Mahmut KARAMEHMETOĞLU, Mustafa CANİKLİOĞLU, Ali Volkan ÖZLÜK

Humerus diyafiz psödoartrozlu olgularda dinamik kompresyon plağı ile açık redüksiyon ve internal fiksasyon uygulamasının sonuçları

Amaç: Humerus diyafiz psödoartrozu nedeniyle dinamik kompresyon plağı kullanılarak açık redüksiyon ve inter¬nal fiksasyon uygulanan olgularda tedavi sonuçları değerlendirildi. Çalışma planı: Çalışmaya, aseptik humerus diyafiz psödoartrozu tanısıyla dinamik kompresyon plağı kullanılarak açık redüksiyon ve internal fiksasyon ile tedavi edilen 18 hasta (12 erkek, 6 kadın; ort. yaş 41; dağılım 22-68) alındı. İlk tedavi olarak yedi hastada konservatif, 11'inde cerrahi yöntemler denenmişti. İlk tedavi ile plak vida uygulaması arasında geçen süre ortalama 12.2 ay (dağılım 5-46 ay) idi. Bütün olgularda radial sinir eksplorasyonu ve otojen kortikospongioz greftleme aynı anda yapıldı. Fonksiyonel sonuçlar Stewart-Hundley ölçütlerine göre değerlendirildi. Olgular ortalama 38.8 ay (12-78 ay) sü¬reyle izlendi. Sonuçlar: Bir olgu dışında tüm olgularda (%94.4) ortalama 5.5 ay (3-8 ay) sürede kaynama sağlandı. Stewart-Hundley ölçütlerine göre, 14 olguda (%77.8) iyi, üçünde (%16.7) orta, birinde (%5.6) kötü sonuç elde edildi. Ameliyat sonrası erken dönemde iki olguda gözlenen radial sinir paralizisi ameliyattan sonra üçüncü ve beşinci aylarda kendiliğinden iyileşti. İki olguda orta derecede refleks sempatik distrofi gelişti. Çıkarımlar: Humerus diyafiz psödoartrozunun dinamik kompresyon plağı kullanılarak yapılan açık redüksiyon ve internal fiksasyon ile tedavisinde, uygun endikasyonlarda ve iyi bir cerrahi teknikle çok başarılı sonuçlar elde edilebilir.

Anahtar Kelimeler:

Radial sinir, Psödoartroz, Kemik plakları, Humerus kırıkları, Kırık tespiti, internal

Treatment results of pseudarthrosis of the humeral shaft by open reduction and internal fixation with dynamic compression plating

Objectives: We evaluated the results of open reduction and internal fixation with the use of dynamic compression plating in patients with pseudarthrosis of the humeral shaft. Methods: Eighteen patients (12 males, 6 females; mean age 41 years; range 22 to 68 years) with aseptic pseudarthrosis of the humeral shaft were treated by open reduction and internal fixation with the use of a dynamic compression plate following unsuccessful treatment with conservative (n=7) or surgical (n=11) methods. The mean interval between the initial and final treatments was 12.2 months (range 5 t 46 months). Exploration of the radial nerve and autogenous corticocancellous grafting were simultaneously performed in all the cases. Functional results were evaluated according to the Stewart-Hundley’s criteria. The mean follow-up was 38.8 months (range 12 to 78 months). Results: Union was achieved in all (%94.4) but one patient within a mean duration of 5.5 months (range 3 to 8 months). Functional results were good in fourteen patients (77.8%), fair in three patients (16.7%), and poor in one patient (5.6%). Radial nerve palsy that occurred in two patients during the early postoperative period underwent spontaneous recovery within three and five months, respectively. Mild reflex sympathetic dystrophy developed in two patients. Conclusion: In selected patients with pseudarthrosis of the humeral shaft, the results of open reduction and internal fixation with the use of dynamic compression plating are excellent, provided that an appropriate surgical technique is employed.

Keywords:

Radial Nerve, Pseudarthrosis, Bone Plates, Humeral Fractures, Fracture Fixation, Internal,

PDF

___

1. Grant RE, Cotler JM, Epps CH Jr, Kim DD. Complications of treatment of fractures of the humeral shaft. In: Epps CH Jr, editor. Complications in orthopaedics surgery. Vol. 1, 3rd ed. Philadelphia: Lippincott; 1994. p. 257-84.
2.Taylor JC. Delayed union and nonunion of fractures. In: Crenshaw AH, editor. Campbell's operative orthopaedics. Vol. 2, 8th ed. St. Louis: Mosby Year Book; 1992. p. 1287-345.
3. Lange RH. Fractures of the humeral shaft. In: Levine AM, editor. Orthopaedic knowledge update. Trauma. Illinois: American Academy of Orthopaedic Surgeons; 1996. p. 25-34.
4.Sarmiento A, Waddell JP, Latta LL. Diaphyseal humeral fractures: treatment options. J Bone Joint Surg [Am] 2001; 83:1566-79.
5.Corley FG, Williams GR, Pearce JC, Rockwood CA Jr. The management of nonunions of the humerus. Instr Course Lect 1990;39:277-88.
6.Foster RJ, Dixon GL Jr, Bach AW, Appleyard RW, Green TM. Internal fixation of fractures and non-unions of the humeral shaft. Indications and results in a multi-center study. J Bone Joint Surg [Am] 1985;67:857-64.
7. Rosen H. The treatment of nonunions and pseudarthroses of the humeral shaft. Orthop Clin North Am 1990;21:725-42.
8.Healy WL, White GM, Mick CA, Brooker AF Jr, Weiland AJ. Nonunion of the humeral shaft. Clin Orthop 1987;(219):206-13.
9.Kocaoglu M, Tomak Y, Eralp L, Bilen FE. The treatment of pseudoarthrosis of the humeral shaft by the Ilizarov method. [Article in Turkish] Acta Orthop Traumatol Turc 2001:35:1-9.
1O.Öztürk K, Aksoy B, Olcay E, Yıldırım OS, Esenyel CZ, Kara AN. Humerus cisim kırıklarının plak ve vida osteosen-tezi ile tedavisi. Acta Orthop Traumatol Turc 1999;33:121-5.
11.Zagorski JB, Latta LL, Zych GA, Finnieston AR. Diaphyseal fractures of the humerus. Treatment with prefabricated braces. J Bone Joint Surg [Am] 1988;70:607-10.
12.Miiller ME. Treatment of nonunions by compression. Clin Orthop 1965;(43):83-92.
13.Rüedi T, Schweiberer L. Scapula, clavicle, humerus. In: Miiller ME, Allgower M, Schneider R, Willenegger H, editors. Manual of internal fixation: techniques recommended by the AO-ASIF group. 3rd ed. Berlin: Springer-Verlag; 1991. p. 427-52.
14. Stewart MJ, Hundley JM. Fractures of the humerus; a comparative study in methods of treatment. J Bone Joint Surg [Am] 1955;37-A:681-92.
15.Esterhai JL Jr, Brighton CT, Heppenstall RB, Thrower A. Nonunion of the humerus. Clinical, roentgenographic, scinti-graphic, and response characteristics to treatment with constant direct current stimulation of osteogenesis. Clin Orthop 1986;(211):228-34.
16.Ring D, Perey BH, Jupiter JB. The functional outcome of operative treatment of ununited fractures of the humeral dia-physis in older patients. J Bone Joint Surg [Am] 1999;81:177-90.
17.Trotter DH, Dobozi W. Nonunion of the humerus: rigid fixation, bone grafting, and adjunctive bone cement. Clin Orthop 1986;(204): 162-8.
18.Kassab SS, Mast JW, Mayo KA. Patients treated for nonunions with plate and screw fixation and adjunctive locking nuts. Clin Orthop 1998;(347):86-92.
19.Wright TW, Miller GJ, Vander Griend RA, Wheeler D, Dell PC. Reconstruction of the humerus with an intramedullary fibular graft. A clinical and biomechanical study. J Bone Joint Surg [Br] 1993;75:804-7.
20.Lin J, Hou SM, Hang YS. Treatment of humeral shaft delayed unions and nonunions with humeral locked nails. J Trauma 2000;48:695-703.
21.Modabber MR, Jupiter JB. Operative management of dia-physeal fractures of the humerus. Plate versus nail. Clin Orthop 1998;(347):93-104.
22.Gregory PR, Sanders RW. Compression plating versus intramedullary fixation of humeral shaft fractures. J Am Acad Orthop Surg 1997;5:215-23.
23.Pritchett JW. Delayed union of humeral shaft fractures treated by closed flexible intramedullary nailing. J Bone Joint Surg [Br] 1985;67:715-8.
24.Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft fractures in patients with multiple injuries. The Sunnybrook experience. J Bone Joint Surg [Br] 1985;67:293-6.
25.McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective, randomised trial. J Bone Joint Surg [Br] 2000;82:336-9.
26.Paramasivan ON, Younge DA, Pant R. Treatment of nonunion around the olecranon fossa of the humerus by intramedullary locked nailing. J Bone Joint Surg [Br] 2000; 82:332-5.
27.Flinkkila T, Ristiniemi J, Hamalainen M. Nonunion after intramedullary nailing of humeral shaft fractures. J Trauma 2001:50:540-4.
28.Barquet A, Fernandez A, Luvizio J, Masliah R. A combined therapeutic protocol for aseptic nonunion of the humeral shaft: a report of 25 cases. J Trauma 1989;29:95-8.
29.Ring D, Jupiter JB, Quintero J, Sanders RA, Marti RK. Atrophic ununited diaphyseal fractures of the humerus with a bony defect: treatment by wave-plate osteosynthesis. J Bone Joint Surg [Br] 2000:82:867-71.
30.Jupiter JB. Complex non-union of the humeral diaphysis. Treatment with a medial approach, an anterior plate, and a vascularized fibular graft. J Bone Joint Surg [Am] 1990;72: 701-7.
31.Marti RK, Verheyen CC, Besselaar PP. Humeral shaft nonunion: evaluation of uniform surgical repair in fifty-one patients. J Orthop Trauma 2002;16:108-15.
32.Rubel IF, Kloen P, Campbell D, Schwartz M, Liew A, Myers E, et al. Open reduction and internal fixation of humeral nonunions: a biomechanical and clinical study. J Bone Joint Surg [Am] 2002;84-A: 1315-22.