Murat KAYALAR, Tulgar TOROS, Emin BAL, Kemal ÖZAKSAR, Yusuf GÜRBÜZ, Yalçın ADEMOĞLU

Proksimal humerus kırıklarında perkütan tespit için hasta seçiminin önemi

Amaç: Proksimal humerus kırıklarında perkütan tespitin endikasyonları, yöntemin dezavantajları, osteoporotik yaşlı hasta grubunda yaşanan sorunlar ve hasta seçiminin önemi değerlendirildi. Çalışma planı: Çalışmada, proksimal humerus boyun kırığı nedeniyle perkütan tespit uygulanan 18 hasta (10 erkek, 8 kadın; ort. yaş 48; dağılım 14-89) incelendi. Bu hastaların sekizi 60 yaşın üzerindeydi. Neer sınıflamasına göre beş hastada iki parçalı, 13 hastada üç parçalı kırık vardı. Hastalara kapalı yerleştirme, perkütan kalın K-teli veya Schanz vidası ile tespit uygulandı. Ortalama 23 ay (dağılım 8-60 ay) takip sonunda hastaların omuz hareket açıklığı ve omuz grafileri değerlendirildi ve Kol Omuz ve El Sorunları Anketi (DASH-T) uygulandı. Sonuçlar: Hastaların omuz abdüksiyonu ortalama 134º (dağılım 30º-160º), elevasyonu 118º (dağılım 30º-140º) bulundu. Hareket açıklığı, iki parçalı kırıkların hepsinde olmak üzere, 11 hastada (%61.1) tamdı. Dört hastada 60º-130º arasında, üç hastada ise 30 derecenin altında abdüksiyon kaybı izlendi. Abdüksiyon kaybı görülen hastaların hepsi 60 yaşın üzerindeydi. Fonksiyonel değerlendirmede DASH-T skoru ortalaması 18 (dağılım 0-77) bulundu. Skorun 10’un altında olduğu 14 hastada ağrı ve fonksiyonel şikayet yoktu. Skoru 10’dan yüksek olan dört hastanın hepsi 70 yaşın üzerindeydi. Çivi migrasyonu yedi hastada (%38.9) meydana geldi. Bu hastaların hepsi 60 yaş üzerindeydi. Bir hastada parsiyel protez uygulaması yapıldı. Kaynamama bir hastada (%5.6), varus/valgus yanlış kaynama dört hastada (%22.2) gözlendi. Hiçbir hastada avasküler nekroz görülmedi. Çıkarımlar: Proksimal humerus kırıklarında perkütan tespit, iki parçalı ve iyi seçilmiş üç parçalı kırıklarda tercih edilebilir. Yaşlı hastalarda komplikasyon oranının yüksek olması nedeniyle hasta seçimi dikkatli yapılmalıdır.

Anahtar Kelimeler:

Humerus kırıkları, Kırık tespiti, internal, Omuz kırıkları, Kemik çivileri, Hasta seçimi, Kemik telleri

The importance of patient selection for the treatment of proximal humerus fractures with percutaneous technique

Objectives: We evaluated the indications and disadvantages of percutaneous technique for proximal humerus fractures in relation to complications encountered in osteoporotic elderly patients and the importance of patient selection. Methods: The study included 18 patients (10 men, 8 women; mean age 48 years; range 14 to 89 years) who underwent percutaneous fixation (closed reduction and pin fixation with Kwires or Schanz screws) for proximal humerus fractures. Eight patients were beyond 60 years of age. According to the Neer classification, five patients had two-part, 13 patients had threepart neck fractures. The patients were evaluated with range of motion of the shoulder, radiographs, and the Disability of Arm Shoulder and Hand questionnaire (DASH). The mean followup was 23 months (range 8 to 60 months). Results: The mean shoulder abduction was 134º (range 30º to 160º) and the mean elevation was 118º (range 30º to 140º). Full range of motion of the shoulder was achieved in 11 patients (61.1%), including all with two-part fractures. Abduction losses of 60º to 130º and less than 30º were seen in four patients and three patients, respectively, all of whom were older than 60 years. The mean DASH score was 18 (range 0 to 77). Fourteen patients having a score of less than 10 had no pain or functional complaints. Four patients with a score of more than 10 were older than 70 years. Pin migration was observed in seven patients (38.9%), all of whom were over 60 years of age. One patient required revision with partial prosthesis. Nonunion was seen in one patient (5.6%) and malunion with a varus/valgus deformity occurred in four patients (22.2%). None of the patients developed avascular necrosis. Conclusion: Percutaneous fixation may be preferred in the treatment of two-part and carefully-selected three-part proximal humerus fractures. Due to high complication rate, patient selection is of primary importance among elderly patients.

Keywords:

Humeral Fractures, Fracture Fixation, Internal, Shoulder Fractures, Bone Nails, Patient Selection, Bone Wires,

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