Cem ÇOPUROĞLU, Hakan GÜRBÜZ, Deniz EŞKİN

Proksimal humerus kırıklarının eksternal fiksasyonla tedavisi

Amaç: Bu çalışmada, kapalı redüksiyon ve eksternal fiksasyon ile tedavi edilen proksimal humerus kırıklı hastaların fonksiyonel sonuçları değerlendirildi. Hastalar ve Yöntemler: Çalışmada proksimal humerus kırıklı 16 hasta (11 erkek 5 kadın; ort. yaş 50.3; dağılım 9-81) geriye dönük olarak değerlendirildi. Tüm hastalara kapalı redüksiyon sonrasında eksternal fiksatör (9 hastaya İlizarov eksternal fiksatör, 7 hastaya monolateral eksternal fiksatör) uygulandı. Kırıklar kaynadıktan sonra eksternal fiksatörler çıkarıldı ve hastaların fonksiyonel sonuçları Constant skoru ile değerlendirildi. Ortalama takip süresi 37 ay (dağılım 4-69 ay) idi. Bulgular: Ortalama kaynama süresi 14 hafta (dağılım 8-22 hafta) idi. Bir hastada kaynama sağlanamadı. Bir hastada humerus başı avasküler nekrozu gelişti. Üç hastada görülen yüzeyel çivi dibi enfeksiyonu pansuman ve medikal tedavi ile iyileşti. Ortalama Constant skoru 81 puan bulundu. Sonuç: Deplase proksimal humerus kırıklarının tedavisinde kapalı redüksiyon ve eksternal fiksasyon uygulaması tatmin edici kırık redüksiyonu ve stabilitesi ve fonksiyonel sonuç sağlar.

Anahtar Kelimeler:

Geriyedönük çalışma, Tedavi sonucu, Humerus kırıkları, Omuz kırıkları, Eksternal fiksatörler, Tedavi başarısızlığı

Treatment of proximal humerus fractures with external fixation

Objectives: We evaluated the functional results of patients who were treated with closed reduction and external fixation for proximal humeral fractures. Patients and Methods: The study included16 patients (11 males, 5 females; mean age 50.3 years; range 9 to 81 years) with proximal humerus fractures. All the patients were treated with closed reduction and external fixation (9 İlizarov external fixator, 7 monolateral external fixator). After bone union was achieved, the fixators were removed and functional results were evaluated with the Constant score. The mean follow-up was 37 months (range 4 to 69 months). Results: The average union time was 14 weeks (range 8 to 22 weeks). Union did not occur in one patient. Avascular necrosis of the humeral head developed in one patient. Superficial pin tract infections were observed in three patients, all of whom were successfully treated with wound care and antibiotic therapy. The mean Constant score was 81. Conclusion: Treatment of displaced fractures of the proximal humerus with closed reduction and external fixation provides satisfactory fracture reduction and stability and functional results.

Keywords:

Retrospective Studies, Treatment Outcome, Humeral Fractures, Shoulder Fractures, External Fixators, Treatment Failure,

PDF

___

1) Flatow EL. Fractures of the proximal humerus. In: Bucholz RW, Heckman JD, editors. Fractures in adults. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 997-104.
2) Fjalestad T, Strømsøe K, Blücher J, Tennøe B. Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital. Arch Orthop Trauma Surg 2005;125:310-6.
3) Gorschewsky O, Puetz A, Klakow A, Pitzl M, Neumann W. The treatment of proximal humeral fractures with intramedullary titanium helix wire by 97 patients. Arch Orthop Trauma Surg 2005;125:670-5.
4) Khodadadyan-Klostermann C, Raschke M, Fontes R, Melcher I, Sossan A, Bagchi K, et al. Treatment of complex proximal humeral fractures with minimally invasive fixation of the humeral head combined with flexible intramedullary wire fixation-introduction of a new treatment concept. Langenbecks Arch Surg 2002;387:153-60.
5) Gabel GT. Fractures. In: Herndon JH, editor. Surgical reconstruction of the upper extremity. Connecticut: Appleton, Lange; 1999. p. 77-96.
6) Crenshaw AH. Fractures of shoulder girdle, arm, and forearm. In: Canale ST, editor. Campbell’s operative orthopaedics. Vol. 3, 9th ed. St. Louis: Mosby; 1998. p. 2281-362.
7) Gauoines RF, Murthy VL, Hoppenfeld S. Proximal humeral fractures. In: Hoppenfeld S, Murthy VL, editors. Treatment and rehabilitation of fractures. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 85-101.
8) Szyszkowitz R, Akalın S. Humerus üst uç. In: Rüedi TP, Murphy WM, Ağuş H, editors. Kırık tedavisinde AO kuralları. Davos: AO Yayınları; 2000. p. 271-289.
9) Smith WR, Kınık H. Kas-iskelet sistemi travma cerrahisi. In: Skinner HB, Alpaslan M, editors. Current ortopedi güncel tanı ve tedavi. 3rd ed. Ankara Güneş Kitabevi; Lange Medical boks; 2005. p. 112-118.
10) Marie-Jeanne TFD, Peeters V, Kastelein GW, Breslau PJ. Proximal humerus fractures a prospective study of the functional outcome after conservative treatment. European Journal of Trauma and Emergency Surgery 2001;3:133-6.
11) Ilchmann T, Ochsner PE, Wingstrand H, Jonsson K. Non-operative treatment versus tension-band osteosynthesis in three- and four-part proximal humeral fractures. A retrospective study of 34 fractures from two different trauma centers. Int Orthop 1998;22:316-20.
12) Fenichel I, Oran A, Burstein G, Perry Pritsch M. Percutaneous pinning using threaded pins as a treatment option for unstable two- and three-part fractures of the proximal humerus: a retrospective study. Int Orthop 2006;30:153-7.
13) Fuchs M, Burchhardt H, Losch A, Stürmer KM. Open reduction and internal fixation of proximal humerus fractures with a cannulated blade plate. Orthop Traumatol 2002;10:268-76.
14) Hessmann MH, Blum J, Hofmann A, Küchle R, Rommens PM. Internal fixation of proximal humeral fractures: current concepts. Eur J Trauma 2003; 29:253-61.
15) Khodadadyan-Klostermann C, Raschke M, Steenlage E, von Seebach M, Melcher I, Haas N. Intramedullary wiring of proximal humerus fractures results of a minimally invasive treatment concept. Eur J Trauma 2002;28:234-41.
16) Hertel R. Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 2005;16 Suppl 2:S65-72.
17) Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, et al. Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 2003;123:74-81.
18) Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M, et al. Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 2007;127:205-10.
19) Panagopoulos AM, Dimakopoulos P, Tyllianakis M, Karnabatidis D, Siablis D, Papadopoulos AX, et al. Valgus impacted proximal humeral fractures and their blood supply after transosseous suturing. Int Orthop 2004;28:333-7.
20) Wachtl SW, Marti CB, Hoogewoud HM, Jakob RP, Gautier E. Treatment of proximal humerus fracture using multiple intramedullary flexible nails. Arch Orthop Trauma Surg 2000;120:171-5.