3 ve 4 Parçalı Humerus Üst Uç Kırıklarının Kilitli Plak ile Tedavisinde Yaş, Cinsiyet ve Kırık Parça Sayısının İşlevsel Sonuçlara Etkisi

Yunus Demirtaş; Serdar Yılmaz; Alper Deveci; Murat Gülçek; Özdamar Fuad Öken; Ahmet Özgür Yıldırım; Sualp Turan; Ahmet Uçaner

EN TR

The Impact of Age, Gender and Fracture Comminution On The Shoulder Function In 3 and 4 Proximal Humeral Fractures Treated With Locking Plate

Abstract

Purpose: We evaluated the relationship between age, fracture communition and the gender with the functional results in patients with three or four-part fractures of the proximal humerus treated with locking plate. Patients and Method: We retrospectively evaluated 36 patients who were treated with anatomic locking plate for comminuted proximal humeral fracture. The mean age of patients was 62.2 range 28-81 . There were 16 female, 20 male patients. 21 patients had three-part fractures, 15 patients had four-part fractures. The patients were divided into 2 groups as follows, below 60 years old as Group A and over 60 years as Group B. The patients were called for the last control to check the state of the fracture radiographically and clinically. The mean follow-up time was 31.1 months range 14-56 months . Mann-Whitney U test was performed to compare the functional state and age and the fracture comminution. Results: All of the patients had fracture union. Two patients had superficial infection healed with antibiotic treatment, 3 patients had partial avascular necrosis, 5 patients had varus malalignment, 2 patients had screw migration, 2 patients had impingement syndrome. The mean Constant score was 71.75±10,6 range 48-98 . The functional results of Group A was higher than Group B independent of fracture comminution p

Keywords

proximal humeral fracture,locking plate,osteopenia,complication,advanced age

3 ve 4 Parçalı Humerus Üst Uç Kırıklarının Kilitli Plak ile Tedavisinde Yaş, Cinsiyet ve Kırık Parça Sayısının İşlevsel Sonuçlara Etkisi

Öz

Amaç: Üç ve dört parçalı humerus üst uç kırıklarında anatomik kilitli plak ile cerrahi tedavi uygulanmış hastaların işlevsel sonuçlarının yaşa, kırıkların parça sayısına ve cinsiyete göre değişimi değerlendirildi. Hastalar ve Yöntem: Humerus üst uç parçalı kırığı nedeniyle anatomik kilitli plak ile tedavi edilen 36 hasta geriye dönük olarak incelendi. Hastaların yaş ortalaması 62.2 yaş dağılımı 28-81 idi. Hastaların 16’sı erkek, 20’si ise bayan idi. 21 hastada 3 parçalı kırık, 15 hastada ise 4 parçalı kırık nedeniyle tedavi gördüğü anlaşıldı. Hastalar 60 yaş altı A grubu 13 hasta ve 60 yaş ve üstü 26 hasta olarak 2 gruba ayrıldı. Hastalar son kontrollerine çağırılarak kırığın radyografik ve işlevsel durumu değerlendirildi. Ortalama takip süresi 31,1 dağılım 14-56 ay idi. Hastaların yaşı ve kırık parça sayısına göre işlevsel durumlarının karşılaştırılması için Mann-Whitney U testi kullanıldı. Bulgular: Çalışmaya alınan hastaların tamamında kırık kaynaması gerçekleşti. İki hastada antibiyotik tedavisi ile iyileşen yüzeyel yara yeri enfeksiyonu, 3 hastada kısmi avasküler nekroz, 5 hastada varus açılanması, 2 hastada vida migrasyonu, 2 hastada ise sıkışma sendromu geliştiği tespit edildi. Hastaların ortalama Constant skoru 71,75±10,6 dağılım 48-98 idi. Hastaların ortalama işlevsel sonuçları kırık parça sayısından bağımsız olarak A grubunda B grubuna göre daha yüksek bulundu p

Anahtar Kelimeler

humerus üst uç kırığı,kilitli plak,osteopeni,komplikasyon,yaşlı hasta

References

Rose SH, Melton LJ 3rd, Morrey BF, Ilstrup DM, Riggs BL. Epidemiologic features of humeral fractures. Clin Orthop Relat Res 1982; 168: 24-30.
Nayak NK, Schickendantz MS, Regan WD, Hawkins RJ. Operative treatment of nonunion of surgical neck fractures of the humerus. Clin Orthop Relat Res 1995;313:200-5.
Sporer SM, Weinstein JN, Koval KJ. The geographic incidence and treatment variation of common fractures of elderly patients. J Am Acad Orthop Surg 2006;14:246-55.
Nho SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD. Innovations in the management of displaced proximal humerus fractures. J Am Acad Orthop Surg 2007;15:12-26.
Demirhan M, Atalar A.C. Humerus üst uç kırıklarına yaklaşım. TOTBİD Dergisi. 2003;2:126-34.
Björkenheim JM, Pajarinen J, Savolainen V: Internal fixation of proximal humeral fractures with a locking compression plate: A retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand 2004;75:741-5.
Gerber C, Werner CM, Vienne P: Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br 2004;86:848-55.
Kayalar M, Toros T, Bal E, Özaksar K, Gürbüz Y, Ademoğlu Y. The importance of patient selection for the treatment of proximal humerus fractures with percutaneous technique. Acta Orthop Traumatol Turc 2009;43:35-41.

Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am 2002;84:1919-25.
Demirhan M, Kılıçoğlu O, Altınel L, Eralp L, Akalın Y. Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma 2003;17:181-8.
Brunner F, Sommer C, Bahrs C et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 2009;23:163–72.
Sudkamp N, Bayer J, Hepp P et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 2009;91:1320–8.
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;40:1292-6.
Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 2009;91:1689-97.
Owsley K, Gorcyzka J. Displacement/screw cutout after open reduction and locked plate fixation of humeral fractures. J Bone Joint Surg Am 2008;90:233-40.
Ong C, Bechtel C, Walsh M, Zuckerman JD, Egol KA. Three- and four- part fractures have poorer function than one-part proximal humerus fractures. Clin Orthop Relat Res. 2011;469:3292-9.
Südkamp NP, Audigé L, Lambert S, Hertel R, Konrad G. Path analysis of factors for functional outcome at one year in 463 proximal humeral fractures. J Shoulder Elbow Surg. 2011;20:1207-16.
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;14:185–91.
Yang H, Li Z, Zhou F, Wang D, Zhong B. A prospective clinical study of proximal humerus fractures treated with a locking proximal humerus plate. J Orthop Trauma. 2011;25:11-7.
Badman B, Frankle M, Keating C, Henderson L, Brooks J, Mighell M. Results of proximal humeral locked plating with supplemental suture fixation of rotator cuff. J Shoulder Elbow Surg 2011;20:616–24.
Korkmaz MF, Aksu N, Göğüş A, Debre M, Kara AN, Işıklar ZU. The results of internal fixation of proximal humeral fractures with the PHILOS locking plate. Acta Orthop Traumatol Turc 2008;42:97-105
Lill H, Hepp P, Korner J, Kassi JP 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.
Charalambous CP, Siddique I, Valluripalli K et al. Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 2007;127:205-10.
Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg Br 2007;89:1206-9.
Leonard M, Mokotedi L, Alao U, Glynn A, Dolan M, Fleming P. The use of locking plates in proximal humeral fractures: comparison of outcome by patient age and fracture pattern. Int J Shoulder Surg 2009;3:85-9.
Yüksel HY, Yilmaz S, Aksahin E, Celebi L, Muratli HH, Bicimoglu A. The results of nonoperative treatment for three- and four-part fractures of the proximal humerus in low-demand patients. J Orthop Trauma 2011;25:588-95.
Agudelo J, Schürmann M, Stahel P et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma 2007;21:676-81.
Lee CK, Hansen HR. Post-traumatic avascular necrosis of the humeral head in displaced proximal humeral fractures. J Trauma 1981;21:788-91.

Details

Primary Language

Turkish

Subjects

-

Journal Section

-

Authors

Yunus Demirtaş

Serdar Yılmaz

Alper Deveci

Murat Gülçek

Özdamar Fuad Öken

Ahmet Özgür Yıldırım

Sualp Turan

Ahmet Uçaner

Publication Date

March 1, 2015

Submission Date

-

Acceptance Date

-

Published in Issue

Year 2015 Number: 1

IZ

https://izlik.org/JA45JR28RM

Cite

RIS / Bibtex

EndNote

Demirtaş Y, Yılmaz S, Deveci A, Gülçek M, Öken ÖF, Yıldırım AÖ, Turan S, Uçaner A (March 1, 2015) 3 ve 4 Parçalı Humerus Üst Uç Kırıklarının Kilitli Plak ile Tedavisinde Yaş, Cinsiyet ve Kırık Parça Sayısının İşlevsel Sonuçlara Etkisi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 1 25–30.