Surgery treatment intraarticular fractures of proximal humerus

Česká verze

Authors: Radek Pikula ¹; Daniel Ira ¹; Milan Krtička ¹; Michal Kýr ²; Michal Mašek ¹
Authors place of work: Tramacentrum FN Brno ¹; Klinika dětské onkologie LF MU a FN Brno ²
Published in the journal: Úraz chir. 21., 2013, č.3

Summary

INTRODUCTION:
Intraarticular fracture of the proximal humerus is considered a severe trauma diagnosis. Surgical treatment is still subject to extensive discussions and numerous articles .

GOAL:
The aim of this study is to compare the functional results of operative treatment methods and conservative treatment with respect to the age of the patient. In our study, we asked three questions. 1. Are fractures C 1.1, C 1.2, C 1.3, C 2.1 indicated for conservative therapy? 2. Are fractures C 2.2, C 2.3, C 3.1 C 3.2 C 3.3 in patients under the age of 65 indicated for osteosynthesis by locking compression plate? 3. Are fractures C 2.2, C 2.3, C 3.1 C 3.2 C 3.3 in patients over 65 years of age indicated for hemiarthroplasty implantation (CKP)?

METHODS:
In our study we included 159 patients with intra-articular fractures of the proximal humerus treated in our department from 2009 to 2013. Majority of patients underwent CT examination and were classified according to the AO (Arbeitsgemeinschaft für osteosynthesefragen) classification [13]. Based on the classification of fractures, biological age, comorbidities, local state and requirements for patient mobility and function, patients were indicated for conservative treatment or surgical procedure and the respective type of osteosynthesis. Pa-tients were then followed up for 1 year after injury, underwent X-ray controls (6 weeks, 3 months and 1 year after injury), and CSS (Constant-Murley Shoulder Score) [5] was evaluated 1 year after injury.

RESULTS:
According to our study, surgical treatment in C 1 and C 2.1 fractures has significantly better results than conservative treatment. Only younger patients had significantly better functional results regardless of the treatment procedure.

In C 2.
2, 2.3 and C 3 fractures we did not prove significantly better functional outcome in surgical treatment by PHILOS (Proximal Humeral Internal Locking System) plate against hemiartroplasty in patients under 65 years of age. And also we did not prove in C 2.2, 2.3 and C 3 fractures better functional outcome in surgical treatment by hemiarthroplasty against PHILOS plate in patients over 65 years of age.

CONCLUSION:
The results of our study confirm the complexity and ambiguity of procedures for treatment of intra-articular fractures of the proximal humerus.

Key words:
proximal humerus fractures, hemiarthoplasty (CKP), PHILOS.

Zdroje

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