Lee, Kwang-Won
(Department of Orthopedic Surgery, Eulji University College of Medicine)
,
Hwang, Yoon-Sub
(Department of Orthopedic Surgery, Eulji University College of Medicine)
,
Kim, Choon-Myeon
(Department of Orthopedic Surgery, Eulji University College of Medicine)
,
Yang, Dae-Suk
(Department of Orthopedic Surgery, Eulji University College of Medicine)
,
Park, Tae-Soo
(Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine)
Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal hume...
Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications. Results: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient). Conclusions: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.
Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications. Results: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient). Conclusions: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.
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제안 방법
The anteroposterior, true anteroposterior, lateral, and axillary view of the shoulder joint were taken. At each radiographic assessment, the presence or absence of bony callus, disappearance of fracture lines, and the union of the displaced bone were examined to measure the progression of bony union. The neck-shaft angle, another indicator of treatment outcome, was measured by measuring the angle between the line perpendicular to the anatomical neck and the line parallel to the humeral shaft (Fig.
Other factors, which related to the surgical method we assessed were accuracy of the anatomical reduction and restoration of medial mechanical support of the proximal humeral fracture. Presence of osteoporosis was determined pre-operatively by calculating the bone density of the lumbar spine and hip joints using Dual Energy X-ray Absorptiometry (DEXA). Using DEXA, osteoporosis was diagnosed if a patient had a T-score of less than -2.
The clinical outcomes of the operation were assessed using Constant score, which comprises of the following assessment variables: pain score (15 points), functional assessment (20 points), range of motions (40 points), and muscle strength (25 points). The Constant score was graded as ‘excellent’ (86−100 points), ‘good’ (71−85 points), ‘moderate’ (56−70 points), or ‘poor’ (0−5 5points).
The inter-observer and intra-observer reliability were assessed by comparing the results of ICCs of measurements taken on two separate occasions by two observers. The inter-observer variation was 0.
The pre-operative radiographic assessment was carried out using plain radiographs. The post-operative plain radiographs were taken immediately postoperative, 2-weeks, 6-weeks, 3-months, 6-months and 1-year after operation. The anteroposterior, true anteroposterior, lateral, and axillary view of the shoulder joint were taken.
This study analyzed the clinical and radiological outcomes of locking plate fixation for proximal humeral fractures. We aimed to determine factors that influence the clinical outcomes of this method, and find out which factors are important for successful clinical outcomes.
대상 데이터
The postoperative complications we observed in patients after treatment of proximal humeral fractures were the perforation of intra-articular locking screws, varus deformity and loosening of the locking screws, and non-union of the bone. All patients were elderly, being of age 86, 81, and 66 years old, respectively. They also had medial metaphyseal comminution and a humeral calcar that was not fixed with locking screws.
6 years (range; 24 to 84 years), and of these, 22 patients were more than 65 years of age and 34 patients were below. The study comprised of 14 male and 42 female patients. The mean follow-up period was 15.
데이터처리
All statistical analysis was performed using a statistics program to evaluate the relationship between the factors concerning clinical and radiographic findings, such as age, sex, bone density, fracture type, presence of medial comminution of the humerus, and medial mechanical support of the fracture. Test of normality was performed to confirm a normal distribution of results.
Test of normality was performed to confirm a normal distribution of results. Then, results were analyzed with an independent T-test and one-way analysis of variance. Scheffe’s test was used as the post-hoc comparison test.
이론/모형
Scheffe’s test was used as the post-hoc comparison test.
성능/효과
If the Constant scores of patients with 4-part fractures were excluded, the average Constant score increased to 73.1 points, which increased the percentage of total patients with a score of or above ‘good’ to 77%.
Nine patients had a score of ‘excellent’ (16%), 28 patients ‘good’ (50%), 13 patients ‘moderate’ (23%), and 6 patients ‘poor’ (11%), giving an overall 66% of patients who had a score of greater than ‘good’.
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