Neslihan AKSU, Sinan KARACA, AYHAN NEDİM KARA, Zekeriya Uğur IŞIKLAR

Minimally invasive plate osteosynthesis (MIPO) in diaphyseal humerus and proximal humerus fractures

Amaç: Çalışmamızın amacı kilitli plak tespit uygulanan humerus diafiz ve proksimal humerus kırıklarında minimal invaziv plak osteosentez (MİPO) tekniği sonuçlarını değerlendirmekti. Çalışma planı: Haziran 2006 - Ekim 2009 tarihleri arasında humerus diafiz ve proksimal humerus kırıklarına açık redüksiyon uygulanan 9 hasta çalışmaya alındı. Bir hastada S3® proksimal humerus plağı, 8’inde PHILOS® plağı kullanıldı. Hastaların yaş ortalaması 75.2 (dağılım: 32-86) idi ve tamamı kadındı. Ortalama takip süresi 33.9 (dağılım: 14.8-54.8) ay olarak gerçekleşti. AO/ASIF sistemine göre dört hastada 12C1, iki hastada 12A1, bir hastada 12A2, ve iki hastada 11A2 tipi kırık vardı. Hastaların hepsinde aksiller ve radial sinir ortaya kondu ve korundu. Constant-Murley skoru ile fonksiyonel ve radyolojik olarak kaynama sonuçları değerlendirildi. Bulgular: Hiçbir hastada kaynamama, implant yetmezliği, avasküler nekroz, aksiller ve radial sinir felci görülmedi. Ortalama Constant-Murley skoru 86.8±2.2 (dağılım: 70-100) idi. Kaynama süresi 3.2 (dağılım: 2.5-5) ay olarak kaydedildi. Çıkarımlar: Humerus diafiz ve proksimal uzanımlı diafiz kırıklarında MİPO uygulaması, kırık fragmanlarında daha az yumuşak doku ve periost hasarı ile kan akımının korunmasına neden olur. Lateral çift insizyonla yapılan bu uygulamada, aksiller ve radial siniri ortaya koymak ve korumak gereklidir. Omuz ve dirsek eklem fonksiyonlarının erken kazanılması, uygun iyileşme zamanı ve mükemmel fonksiyonel sonuçları ile bu tespit şekli, bu kırık tipinde avantajlı bir yöntemdir

Diyafizer ve proksimal humerus kırıklarında minimal invaziv plak osteosentez (MİPO) uygulaması

Objective: Our aim was to evaluate the results of minimally invasive plate osteosynthesis (MIPO) using locking plates in diaphyseal humerus and proximal humerus fractures. Methods: Nine patients who underwent open reduction and MIPO for the treatment of diaphyseal and proximal humerus fractures between June 2006 and October 2009 were included in this study. One S3® and 8 PHILOS® plates were used. Mean age was 75.2 (range: 32 to 86) years and all patients were females. Mean follow-up was 33.9 (range: 14.8 to 54.8) months. According to AO/ASIF classification, four patients had 12C1, two patients 12A1, one patient 12A2, and two patients 11A2 fractures. Axillary and radial nerves were explored and protected in all patients. Patients were evaluated radiographically for union and functionally using the Constant-Murley score. Results: None of the patients had nonunion, avascular necrosis, axillary or radial nerve paralysis or implant failure. Mean Constant-Murley score was 86.8±2.2 (range: 70 to 100). Mean union time was 3.2 (range: 2.5 to 5) months. Conclusion: MIPO of humerus diaphysis and proximal fractures allows for preservation of blood supply in fracture fragments, owing to less soft tissue and periosteal injury. When the procedure is performed with the lateral double incision, exposure and preservation of the axillary and radial nerves are necessary. Early return of function in the shoulder and elbow joints and favorable healing time are the major advantages of this method in this rare subset of humerus fractures.

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