Surgical Management of Proximal Humeral Fractures Using the Hackethal (Zifko) Method – A Case Review
Authors:
K. Šmejkal; T. Dědek *; I. Žvák; J. Trlica *; J. Folvarský *; I. Počepcov *; J. Zahradníček *; T. Holeček *; J. Kočí *; M. Frank
Authors‘ workplace:
Katedra válečné chirurgie, Fakulta vojenského zdravotnictví UO, Hradec Králové
vedoucí katedry: doc. MUDr. Alexander Ferko, CSc.
; Chirurgická klinika, Fakultní nemocnice Hradec Králové, přednosta: doc. MUDr. Alexander Ferko, CSc.
*
Published in:
Rozhl. Chir., 2008, roč. 87, č. 2, s. 101-107.
Category:
Monothematic special - Original
Overview
Background:
Fractures of the proximal humerus actually represent 5% of all fractures and 45% of all humeral fractures with the highest incidence in women over 60 years of age. The outcomes of the greatest concern at these patients (pain, function of the shoulder and activities of daily living) get worse with age, osteoporosis, grading of fracture type and of initial fracture displacement [1]. According to the literature (Evidence Based Medicine – EBM level II–III) operative treatment of displaced fractures reduces pain and need for assistance in activities of daily living, but open reduction with internal fixation by conventional screws and plates was connected with implant loosening, infection and avascular necrosis, whereas closed reduction with different methods of miniinvasive percutaneous stabilisation is threatened by primary malreduction.
Aim:
Evaluation of clinical and functional outcomes and analysis of results of proximal humerus fractures treated by closed or percutaneous reduction and intramedullary fixation by means of bundle of Kirschner wires after Zifko [2].
Design:
Retrospective descriptive study – case serie.
Material and methods:
Within January 1, 2005 – December 31, 2005 there were 87 patients with 87 two- and three-fragments fractures of proximal humerus (according to Neer’s classification) operated at our institution, from which 76 by the method after Zifko. 36 patients from these 76 came to final evaluation (follow-up rate 47%). AO fracture types were: A2–36%, A3–33%, B1–19%, C1–12%.
Results:
The resulting Constant-Murley (CM) [3] score reached in mean 89 points with 89% of excellent – good functional results. Complications were recorded in 30% of cases and were represented mainly by proximal migration of K-wires. Avascular necrosis of humeral head occured in two cases (5,5%).
Conclusion:
In spite of low follow-up rate we conclude, that the method of closed reduction and intramedullary fixation of two- and three-part fractures of proximal humerus after Zifko offers above-average final results with acceptable rate of complications, mostly not severe ones. The essential pre-condition of good result is proper reduction – closed of percutaneous one. On the contrary, suboptimal results correlate with primary and secondary malreductions.
The incidence of latter increases in intraarticular fracture types with small fragment of head and thus with insuficient implant retention. To evaluate the merit of the method in relation to angle-stable extra-/ or intramedullary implants, the prospective trials are needed.
Key words:
proximal humeral fractures – intramedullary Kirschner wires – minimal invasive osteosynthesis
Sources
1. Olsson, C., Nordquist, A., Petersson, C. J. Long-term outcome of a proximal humerus fracture predicted after 1 year: a 13-year prospective population-based follow-up study of 47 patients. Acta Orthop., 2005, Vol. 76, p. 397–402.
2. Zifko, B., Poigenfurst, J. Treatment of unstable fractures of the proximal end of the humerus using elastic curved intramedullary Wires. Unfallchirurgie, 1987, Vol. 13, p. 72–81.
3. Constant, C. R., Murley, A. H. A clinical method of functional assesment of the shoulder. Clin. Orthop., 1987, Vol. 214, p. 160–164.
4. Lin, J. Effectiveness of locked nailing for displaced three – Part proximal humeral fractures. J. Trauma, 2006, Vol. 61, p. 363–374.
5. Khodadadyan-Klostermann, C., Raschke, M. , Fontes, R., et al. Treatment of complex proximal humeral fratures with minimally invasive fixation of the humeral head combined with flexible intramedullary wire fixation – introduction of a new concept. Langenbecks Arch. Surg., 2002, Vol. 387, p. 153–160.
6. Resch, H., Povacz, P. , Frohlich, R., et al. Percutaneus fixation of three and four parts fractures of the proximal humerus. J. Bone Joint Surg. Br., 1997, Vol. 79, p. 295–300.
7. Chen, C. Y., Chao, E. K., Tu, Y. K., et al. Closed management and percutaneus fixation of unstable proximal humerus fractures. J. Trauma, 1998, Vol. 45, p. 1039–1045.
8. Fenichel, I. , Oran, A. , Burstein, G., et al. Percutaneus pinning using threaded pins as a treatment option for unstable two- and three- part fractures of the proximal humerus: a retrospective study. Int. Orthop., 2006, Vol. 30, p. 153–157.
9. Qidwai, S. A. Treatment of proximal humeral fractures by intramedullary Kirschner wires. J. Trauma, 2001, Vol. 50, p. 1090–1095.
10. Takeuschi, R. , Koshino, T. , Nakazawa, A., et al. Minimally invasive fixation for unstable two – Part proximal humeral fractures: surgical techniques and clinical results using J nail. J. Orthop. Trauma, 2002, Vol. 16, p. 403–408.
11. Hessman, M., Gotzen, L. , Gehling, H. et al. Operative treatment of displaced proximal humeral fractures: two – year results in 99 cases. Acta Chir. Belg., 1998, Vol. 98, p. 212–219.
12. Kunner, E. H. , Siebler, G. Dislocation fractures of the proximal humerus – results following surgical treatment. A follow up study of 167 cases. Unfallchirurgie, 1987, Vol. 13, p. 64–71.
13. Meier, R. A., Messmer, P., Regazzoni, P., et al. Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate. J. Orthop. Trauma, 2006, Vol. 20, p. 253–260.
14. Hintermann, B., Trouiller, H. H. , Schafer, D., et al. Rigid internal fixation of fractures of the proximal humerus in older patient. J. Bone Joint Surg. Br., 2000, Vol. 82-B, p. 1107–1112.
15. Bjorkenheim, J.-M. , Pajarinen, J., Savolainen, V., et al. Internal fixation of proximal humeral fractures with a locking compression plate. Acta Orthop. Scand., 2004, Vol. 75, p. 741–745.
16. Koukasis, A., Apostolou, C. D., Teneja, T., et al. Fixation of Proximal Humerus Fractures Using the PHILOS plate: Early Experience. Clin. Orthop., 2006, vol. 442, p. 115–120.
17. Fankhauser, F. , Boldin, C., Schippinger, G., et al. A new locking plate for unstable fractures of the proximal humerus. Clin. Orthop., 2005, Vol. 430, p. 176–181.
18. Rose, P. S. , Adams, C. R., Torchia, M. E., et al. Locking plate fixation for proximal humeral fractures: Initial results with a new implant. J. Shoulder Elbow Surg., 2007, Vol. 16, p. 202–207.
19. Charalambous, C. P., Sidiqque, I. , Valluripalli, K., et al. Proximal humeral internal locking system (PHILOS) for treatment of proximal humeral fractures. Arch. Orthop. Trauma. Surg., 2007, Vol. 127, p. 205–210.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
![Issue 2](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/c51cb7cfb8c5331a0a832a6ca7814062.jpeg)
2008 Issue 2
Most read in this issue
- „Tension Free“ Method in Inguinal Hernioplasty Using CHS 100 Mesh – Our Experience
- Benefits of Intraoperative N. Laryngeus Recurrens Neuromonitoring in Thyroid Surgery
- Spontaneous Rupture of Ductus Choledochus in Acute Pancreatitis – a Case Report
- Surgical Management of Proximal Humeral Fractures Using the Hackethal (Zifko) Method – A Case Review