Treatment of Proximal Humeral Fractures by Angular Stabile, Antegrade, Interlocking Intramedullar Nail
Authors:
P. Višňa; E. Beitl; E. Jaganjac; J. Kalvach; Z. Šmídl
Authors‘ workplace:
Traumatologické oddělení, Chirurgická klinika UK 2. LF a FN Motol, Praha, přednosta: prof. MUDr. J. Hoch, CSc.
Published in:
Rozhl. Chir., 2007, roč. 86, č. 4, s. 194-200.
Category:
Monothematic special - Original
Overview
Introduction:
The objective of our study is evaluation of clinical and radiological results of dislocated proximal humeral fractures, treated by direct, angular stabile, antegrade and interlocking implants Targon PH (Aesculap, Tuttlingen, Germany).
Methods:
We evaluated 102 patients (76 female and 26 male), average age was 67.3 years (26–87 years). The standard nail was used in 73 cases; the long one was used in 29 cases. We interpreted functional results (Constant’s score and relative Constant’s score), radiological results and postoperative complications.
Results:
Constant’s score achieved average 51.3 points – 3 weeks after operation, 67.4 points – after 6 months and 75.8 points – after 1 year. Value of the relative Constant’s score was 59.3%, 75.9% and 83.5%. We have found trend to the poorer functional outcomes in all complicated four-part fractures; especially in cases with disarticulation.
The complete bone healing was reached in:
63.7% up to 3 months, 95.1% up to 6 months and 99 % up to 1 year. We detected 1case of the pseudoarthrosis.
We had 37 complications in our 102 patients group in the first year after operation. The migration of the proximal fixation screws was most frequent complication – 12 patients. Eight times the humeral head aseptic necrosis appeared (5x partial, 3x complete), 3 times redislocation of tuberculum maius was found. We made reoperation 2 times by Phillos plate (1x for pseudoarthrosis, 1x for broken screws).
Conclusions:
Targon PH is intramedullary nail stabilisation of proximal humeral fractures by angular stabile, antegrade, interlocking system. We consider it for mini-invasive technique that provides high stability in osteoporotic bone and allows immediate postoperative shoulder mobilisation.
Key words:
antegrade intramedulary nail – fractures of proximal humerus
Sources
1. Resch, H., Povacz, P., Fröhlich, R., Wambacher, M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J. Bone Joint Surg., 1997; 79(B): 295–300.
2. Mittlmeier, W. F., Stedtfeld, H. W., Esery, A., Beck, M., Frosch, B., Gradl, G. Stabilization of Proximal Humeral Fractures with an Angular and Sliding Stable Antegrade Locking Nail (Targon PH). J. Bone Joint Surg., 2003; 85(A), S(4): 136–146.
3. Stedtfeld, H. W., Attmanspacher, W., Thales, K., Frosch, B. Fixation of Humeral head Fractures with Antegrade Intramedullary Nailing. Zentralbl. Chir., 2003; 128: 6–11.
4. Lill, H., Korner, J., Glasmacher, S., Hepp, P., Just, A., Verheyden, P., Josten, C. Crossed Screw Osteosynthesis of Proximal Humerus Fractures. Unfallchirurg., 2001; 104: 852–859.
5. Blum, J., Hessmann, M. H., Romens, P. M. Treatment os Proximal Metaphyseal Fractures of the Humerus with Interlocked Nailing and a Spiral Blade – Early Experience with a New Implant System. Aktuelle Traumatol., 2003; 33: 7–13.
6. Rajasekhar, C., Ray, P. S., Bhamra, M. S. Fixation of Proximal Humeral Fractures with a Polarus Nail. J. Shoulder Elbow Surg., 2001; 10: 7–10.
7. Neer, Ch. S. Displaced Produmal Humeral Fractures. J. Bone Joint Surg., 1970; 52(A): 1077–1089.
8. Hintermann, M., Trouillier, H. H., Schäfer, D. Rigid Internal Fixation of Fractures of the Produmal Humerus in Older Patiens. J. Bone Joint Surg., 2000; 82(B): 1107–1112.
9. Schai, P., Imhoff, A., Preiss, S. Cominuted Humeral Head Fractures: a multicenter analysis. J. Shoulder Elbow Surg., 1995; 4: 319–330.
10. Hart, R., Janeček, M., Buček, P. Treatment of displaced fractures of the proximal humerus. Osteo. Trauma Care, 2002; 10: 68–75.
11. Hart, R., Buček, P., Nestrojil, P., Zelníček, P. Výsledky operační léčby zlomenin proximálního humeru. Úraz. chir., 2001; 9(2): 6–17.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2007 Issue 4
Most read in this issue
- Treatment of Gunshot Wounds and Prevention of Complications during the Healing Process
- Surgical Treatment of Bleeding Gastroduodenal Ulcer
- Acute Intestinal Ischaemia
- Long-term Results after Radical Resections for Pancreatic Ductal Adenocarcinoma – 10 Years Experience