Background: Indirect reduction technique offers a valid option in the treatment of proximal humerus fracture. The purpose of this study is to evaluate the functional outcome and the complication rate after indirect reduction and internal fixation of unstable proximal humeral fractures with use of a ...
Background: Indirect reduction technique offers a valid option in the treatment of proximal humerus fracture. The purpose of this study is to evaluate the functional outcome and the complication rate after indirect reduction and internal fixation of unstable proximal humeral fractures with use of a locking plate. Methods: Twenty four patients with acute proximal humerus fracture were managed with indirect reduction and internal fixation with a locking plate. The mean follow-up period was 15.5 months. Results: The anatomical reduction of the medial cortex buttress was seen in 16 patients (66%) of the Group A and the non-anatomical reduction was seen in 8 patients (33%) of the Group B. Mean union time was $3.2{\pm}1.9$ months; it was $2.2{\pm}0.6$ months in the Group A and $5.3{\pm}2.2$ months in the Group B (p < 0.05). In our series, there were 6 cases of complications and these include 2 cases of varus malunion, 2 cases of shoulder stiffness, 1 case of heterotrophic ossification, 2 cases of screw perforation and 1 case of impingement. Conclusions: We conclude from our studies that indirect reduction and internal fixation using locking plate for acute proximal humerus fracture can give good results with bony union and predictable good overall functional outcome. If the medial cortex buttress is well maintained, a better anatomical reduction would be achieved, the union would be prompted, the pain would be further reduced and the range of the motion would be recovered more promptly.
Background: Indirect reduction technique offers a valid option in the treatment of proximal humerus fracture. The purpose of this study is to evaluate the functional outcome and the complication rate after indirect reduction and internal fixation of unstable proximal humeral fractures with use of a locking plate. Methods: Twenty four patients with acute proximal humerus fracture were managed with indirect reduction and internal fixation with a locking plate. The mean follow-up period was 15.5 months. Results: The anatomical reduction of the medial cortex buttress was seen in 16 patients (66%) of the Group A and the non-anatomical reduction was seen in 8 patients (33%) of the Group B. Mean union time was $3.2{\pm}1.9$ months; it was $2.2{\pm}0.6$ months in the Group A and $5.3{\pm}2.2$ months in the Group B (p < 0.05). In our series, there were 6 cases of complications and these include 2 cases of varus malunion, 2 cases of shoulder stiffness, 1 case of heterotrophic ossification, 2 cases of screw perforation and 1 case of impingement. Conclusions: We conclude from our studies that indirect reduction and internal fixation using locking plate for acute proximal humerus fracture can give good results with bony union and predictable good overall functional outcome. If the medial cortex buttress is well maintained, a better anatomical reduction would be achieved, the union would be prompted, the pain would be further reduced and the range of the motion would be recovered more promptly.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
가설 설정
(A) Locking plate is placed and the non-locking hole just distal to the fracture is drilled perpendicular to the bone fragment. (B) As the screw is tightened, the valgus deformity will reduce itself. (C) Locking and non-locking screw should be placed proximally to catch the head of the humerus.
(C) Locking and non-locking screw should be placed proximally to catch the head of the humerus. (D) The intraoperative x-ray show good alignment.
제안 방법
Postoperative clinical evaluations were performed regularly on an outpatient basis (at 4 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively and at the last followup) and the results of the last follow-up were analyzed. Postoperative subjective pain score was measured using the visual analog scale (VAS).
The aim of this study is to assess fracture healing, functional outcome and complications of proximal humeral fractures, treated by indirect reduction with a locking plate fixation.
이론/모형
Postoperative clinical evaluations were performed regularly on an outpatient basis (at 4 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively and at the last followup) and the results of the last follow-up were analyzed. Postoperative subjective pain score was measured using the visual analog scale (VAS). Postoperative shoulder range of motion (ROM), forward flexion, external rotation at the side, internal rotation to the back, and abduction were assessed.
성능/효과
26) used the indirect reduction technique in 98 patients with unstable proximal humeral fracture. According to the reference, results of UCLA-rating system and Constant score were good to excellent in 76% and 69% of fractures, respectively. In addition, according to these authors, there were three cases of complete humeral head necrosis due to an avascular necrosis.
참고문헌 (34)
Bigliani LU, McCluskey GM 3rd. Prosthetic replacement in acute fractures of the proximal humerus. Semin Arthroplasty. 1990;1(2):129-37.
Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg. 1989;108(5):285-7.
Robinson CM, Page RS, Hill RM, Sanders DL, Court-Brown CM, Wakefield AE. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am. 2003;85-A(7):1215-23.
Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87-92.
Fjalestad T, Stromsoe K, Blucher J, Tennoe B. Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital. Arch Orthop Trauma Surg. 2005;125(5):310-6.
Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg. 2009;18(4):612-21.
Hessmann MH, Korner J, Hofmann A, Sternstein W, Rommens PM. Angle-fixed plate fixation or double-plate osteosynthesis in fractures of the proximal humerus: a biomechanical study. Biomed Tech. 2008;53(3):130-7.
Robinson CM, Amin AK, Godley KC, Murray IR, White TO. Modern perspectives of open reduction and plate fixation of proximal humerus fractures. J Orthop Trauma. 2011;25(10):618-29.
Robinson CM, Wylie JR, Ray AG, et al. Proximal humeral fractures with a severe varus deformity treated by fixation with a locking plate. J Bone Joint Surg Br. 2010;92(5):672-8.
Schumer RA, Muckley KL, Markert RJ, et al. Biomechanical comparison of a proximal humeral locking plate using two methods of head fixation. J Shoulder Elbow Surg. 2010;19(4):495-501.
Papadopoulos P, Karataglis D, Stavridis SI, Petsatodis G, Christodoulou A. Mid-term results of internal fixation of proximal humeral fractures with the Philos plate. Injury. 2009;40(12):1292-6.
Foruria AM, Carrascal MT, Revilla C, Munuera L, Sanchez-Sotelo J. Proximal humerus fracture rotational stability after fixation using a locking plate or a fixed-angle locked nail: the role of implant stiffness. Clin Biomech. 2010;25(4):307-11.
Walsh S, Reindl R, Harvey E, Berry G, Beckman L, Steffen T. Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech. 2006;21(10):1027-31.
Olsson C, Nordqvist A, Petersson CJ. Increased fragility in patients with fracture of the proximal humerus: a case control study. Bone. 2004;34(6):1072-7.
Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21(3):185-91.
Tingart MJ, Apreleva M, von Stechow D, Zurakowski D, Warner JJ. The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br. 2003;85(4):611-7.
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160-4.
Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68(8):1136-44.
Hertel R. Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int. 2005;16 Suppl 2:S65-72.
Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004;13(4):427-33.
Hessmann M, Baumgaertel F, Gehling H, Klingelhoeffer I, Gotzen L. Plate fixation of proximal humeral fractures with indirect reduction: surgical technique and results utilizing three shoulder scores. Injury. 1999;30(7):453-62.
Konrad G, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg Am. 2010;92 Suppl 1 Pt 1:85-95.
Kuner EH. Fractures of the proximal humerus. Classification and treatment principles. Z Unfallchir Versicherungsmed. 1992;85(3):156-62.
Sturzenegger M, Fornaro E, Jakob RP. Results of surgical treatment of multifragmented fractures of the humeral head. Arch Orthop Trauma Surg. 1982;100(4):249-59.
Hardeman F, Bollars P, Donnelly M, Bellemans J, Nijs S. Predictive factors for functional outcome and failure in angular stable osteosynthesis of the proximal humerus. Injury. 2012;43(2):153-8.
Spross C, Platz A, Erschbamer M, Lattmann T, Dietrich M. Surgical treatment of Neer Group VI proximal humeral fractures: retrospective comparison of PHILOS(R) and hemiarthroplasty. Clin Orthop Relat Res. 2012;470(7):2035-42.
Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22(3):159-64.
※ AI-Helper는 부적절한 답변을 할 수 있습니다.