Cemal KAZIMOĞLU, Tayfun BACAKSIZ, İhsan AKAN, Mehmet ÖZDEMİR, Mahmut TUNÇEZ, Özgür Doğan AYDIN

HUMERUS PROKSİMAL KIRIK YÖNETİMİNDE AKUT VE BAŞARISIZ OSTEOSENTEZ SONRASI UYGULANAN TERS OMUZ ARTROPLASTİSİNİN KARŞILAŞTIRILMASI

Giriş: İleri yaşta meydana gelen kompleks ve osteoporotik proksimal humerus kırıklarının cerrahi tedavisi oldukça zordur. Teknolojinin gelişmesi ile birlikte bu zor kırıkların cerrahisinde ters omuz artroplastisi (TOA) kullanılmaya başlamıştır. Bu çalışmamızdaki amacımız humerus proksimal kırık cerrahisinde akut ve başarısız cerrahi sonrası TOA yapılan hastaların klinik ve fonksiyonel sonuçlarını karşılaştırmayı amaçladık. Gereç ve Yöntem: Geriye dönük olarak kliniğimizde ardışık yapılan TOA’lar incelendiğinde kriterlerimize uyan 17 hasta çalışmaya alındı. Bunlardan 10 hastaya hemen kırık sonrası TOA, 7 hastaya ise başarısız osteosentez sonrası TOA (BOTOA) uyglulandı. Rotator manşet hastalığı, glenohumeral artroz nedeniyle TOA yapılan hastalar ve son kontrollerine gelmeyen hastalar çalışmaya alınmadı. Hastalar; yaş, cinsiyet, etkilenen taraf, anestezi şekli, ameliyat süresi, perop kan transfüzyonu, hastanede kalış süresi, takip süresi, Neer sınıflaması, Constant skoru, QDASH skorları ve eklem hareket açıklıkları açısından incelendi. Bulgular: Cinsiyet, etkilenen taraf, anestezi şekli, ameliyat süresi, kan transfüzyonu, hastanede kalış süresi, takip süresi, Neer sınıflaması karşılaştırıldığında her iki grup arasında anlamlı fark bulunmadı. Yapılan son kontrollerde ise Constant skoru, QDASH (Kol, Omuz ve El Sorunları Anketi) skoru, VAS skoru açısından incelendiğinde her iki grup arasında fark bulunmadı. Sonuç: Çok parçalı ve osteoporotik proksimal humerus kırıklarında ters omuz artroplastisi; akut olarak ya da başarısız osteosentez sonrası uygulanabilir bir tedavi seçeneğidir.

COMPARISON OF REVERSE SHOULDER ARTHROPLASTY PERFORMED AFTER ACUTE AND FAILURE OF OSTEOSYNTHESIS IN MANAGEMENT OF HUMERUS PROXIMAL FRACTURE

Introduction: Surgical treatment of complex and osteoporotic proximal humeral fractures in advanced age is very difficult. With the development of technology, reverse shoulder arthroplasty (RSA) has begun to be used in the surgery of these difficult fractures. Our aim in this study was to compare the clinical and functional results of patients who underwent RSA after acute and failed surgery in proximal humeral fracture surgery. Material and Method: When consecutive RTAs performed in our clinic were examined retrospectively, 17 patients who met our criteria were included in the study. Of these, RSA was applied to 10 patients immediately after fracture, and RSA (FORSA) to 7 patients after failed osteosynthesis. Patients who underwent RSA due to rotator cuff disease, glenohumeral arthrosis, and patients who did not attend their final follow-up were excluded from the study. Patients; age, gender, affected side, type of anesthesia, operation time, perop blood transfusion, hospital stay, follow-up time, Neer classification, Constant score, QDASH (Quick Disabilities of Arm, Shoulder & Hand) scores and range of motion were evaluated. Results: When gender, affected side, type of anesthesia, duration of surgery, blood transfusion, length of hospital stay, follow-up period, Neer classification were compared, no significant difference was found between the two groups. In the final controls, when the Constant score, QDASH score, and VAS score were examined, no difference was found between the two groups. Conclusion: Revers shoulder arthroplasty in multi-fragmented and osteoporotic proximal humeral fractures; It is a viable treatment option acutely or after unsuccessful osteosynthesis.

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