Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Minimal Invasive Plate Osteosynthesis in Proximal Humerus Fractures

상완골 근위부 골절에서의 최소 침습적 금속판 술식

  • Shin, Sang-Jin (Department of Orthopaedic Surgery, Ewha Womans University College of Medicine) ;
  • Do, Nam-Hun (Department of Orthopaedic Surgery, Ewha Womans University College of Medicine) ;
  • Song, Mi-Hyun (Department of Orthopaedic Surgery, Ewha Womans University College of Medicine) ;
  • Sohn, Hoon-Sang (Department of Orthopaedic Surgery, National Medical Center)
  • 신상진 (이화여자대학교 의학전문대학원 정형외과학교실) ;
  • 도남훈 (이화여자대학교 의학전문대학원 정형외과학교실) ;
  • 송미현 (이화여자대학교 의학전문대학원 정형외과학교실) ;
  • 손훈상 (국립중앙의료원 정형외과)
  • Received : 2010.08.05
  • Accepted : 2010.10.26
  • Published : 2010.12.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: In this study we introduced minimal invasive plate osteosynthesis (MIPO) and analyzed clinical outcomes to determine the effectiveness of this intervention in proximal humerus fractures. Materials and Methods: We studied 27 patients including 16 cases with a 2-part fracture, 10 cases with a 3-part fracture, and 1 case with a 4-part fracture. Clinical outcomes were evaluated using UCLA score, KSS score and recovery of range of motion. Time to union and humerus neck-shaft angle change were estimated by radiologic assessment. The average follow up period was 19 months. Results: UCLA scores were "excellent" for 15 patients, "good" for 12 patients. The mean KSS score was 91.4 at final follow-up. The average shoulder range of motion was $167.2^{\circ}$ in forward elevation. Bone union occurred by 14.1 weeks postoperatively. Humerus neck-shaft angle recovery was "excellent" in 24 patients and "moderate" in 3 patients. There were no complications such as axillary nerve paralysis, deep infection, or subacromial impingement of the plate. Conclusion: MIPO for proximal humerus fractures is an effective procedure if performed with sufficient understanding of the anatomical structures. MIPO leads to minimized dissection of soft tissue, low complication rates and early recovery of range of motion.

목적: 상완골 근위부 골절에 대하여 최소 침습적 금속판 술식을 시행하고, 임상 결과를 분석하여 유용성을 알아보고자 하였다. 대상 및 방법: 상완골 근위부 골절에 대하여 최소 침습적 금속판 술식을 시행한 27명을 대상으로 하였다. 골절 분류는 2분 골절 16예, 3분 골절 10예였으며, 4분 골절 1예가 포함되었다. 임상적 평가는 UCLA 점수와 KSS 점수 및 운동 범위 회복 정도와 합병증 발생 여부를 조사하였으며, 방사선학적으로는 골유합 기간과 경간각 회복 정도를 평가하였다. 평균 추시 기간은 19개월이었다. 결과: 최종 추시에서 UCLA 점수는 우수가 15예, 양호가 12예였으며 KSS 점수는 평균 91.4점이었다. 또한 최종 견관절 운동 범위는 전방 거상이 평균 $167.2^{\circ}$로 측정되었다. 모든 환자에서 수술 후 평균 14.1주에 골유합을 얻었으며, 경간각 회복 정도는 우수가 24예였으며 보통이 3예였다. 액와 신경 마비나 심부 감염, 금속판의 충돌 증후군 등의 합병증은 발생하지 않았다. 결론: 상완골 근위부 골절에 대한 최소 침습적 금속판 술식은 충분한 해부학적 지식을 숙지하고 시행하면 주변 연부 조직 박리를 최소화하여 합병증 발생을 감소시키고 조기 관절 운동을 가능하게 하므로 상완골 근위부 골절 치료의 효과적인 수술 방법의 하나로 사료된다.

Keywords

References

  1. Agudelo J, Schurmann M, Stahel P, et al.: Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma, 21: 676-681, 2007. https://doi.org/10.1097/BOT.0b013e31815bb09d
  2. Bono CM, Grossman MG, Hochwald N, Tornetta P: Radial and axillary nerve: Anatomic considerations for humeral fixation. Clin Orthop Relat Res, 379: 259-264, 2000. https://doi.org/10.1097/00003086-200010000-00031
  3. Chapman JR, Henley MB, Agel J, Benca PJ: Randomized prospective study of humeral shaft fracture fixation: Intramedullary nails versus plates. J Orthop Trauma, 14: 162-166, 2000. https://doi.org/10.1097/00005131-200003000-00002
  4. DePalma AF, Cautilli RA: Fractures of the upper end of the humerus. Clin Orthop Relat Res, 20: 73-93, 1961.
  5. Gardner MJ, Boraiah S, Helfet DL, Lorich DG: Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma, 22: 195-200, 2008. https://doi.org/10.1097/BOT.0b013e31815b3922
  6. Gardner MJ, Weli Y, Baker JU, Kelly BT, Helfet DL, Lorich DG: The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma, 21: 185-191, 2007. https://doi.org/10.1097/BOT.0b013e3180333094
  7. Gerber C, Schneeberger AG, Vinh TS: The arterial vascularization of the humeral head. An anatomical study. J Bone Joint Surg Am, 72: 1486-1494, 1990.
  8. Ha SS, Kim JY, Hong KD, Sim JC, Kang JH, Park KH: Operative treatment with Locking Compression Plate (LCP) in proximal humerus plate. J Korean Shoulder Elbow Soc, 11: 137-142, 2008. https://doi.org/10.5397/CiSE.2008.11.2.137
  9. Helmy N, Hintermann B: New trends in the treatment of proximal humerus fractures. Clin Orthop Relat Res, 442: 100-108, 2006. https://doi.org/10.1097/01.blo.0000194674.56764.c0
  10. Horak J, Elosser B: Epidemiology of fractures of the upper end of the humerus. Clin Orthop Relat Res, 112: 250-253, 1975.
  11. Lau TW, Leung F, Chan CF, Chow SP: Minimally invasive plate osteosynthesis in the treatment of proximal humeral fracture. Int Orthop, 31: 657-664, 2007. https://doi.org/10.1007/s00264-006-0242-4
  12. Lee CW, Shin SJ: Prognostic factors for unstable proximal humerus fractures treated with lockingplate fixation. J Shoulder Elbow Surg, 18: 83-88, 2009. https://doi.org/10.1016/j.jse.2008.06.014
  13. Kayalar M, Toros T, Bal E, Ozaksar K, Gurbuz Y, Ademog ̌lu Y: The importance of patient selection for the treatment of proximal humerus fractures with percutaneous technique. Acta Orthop Traumatol Turc, 43: 35-41, 2009. https://doi.org/10.3944/AOTT.2009.035
  14. Mira A, Kapur R, Maffulli N: Complex proximal humeral fractures in adults- A systemic review of management. Injury, 232: 363-372, 2001.
  15. Neer CS: Displaced proximal humeral fractures. Part I. Classification and evaluation. J Bone Joint Surg Am, 52: 1077-1089, 1970.
  16. Paavolainen P, Bjorkenheim JM, Slatis P, Paukku P: Operative treatment of severe proximal humeral fractures. Acta Orthop Scand, 54: 374-379, 1983. https://doi.org/10.3109/17453678308996587
  17. Park CH, Park SH, Seo JS: Internal fixation of proximal humerus fracture with Locking Compression Plate. J Korean Shoulder Elbow Soc, 12: 44-52, 2009. https://doi.org/10.5397/CiSE.2009.12.1.044
  18. Plecko M, Kraus A: Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol, 17: 25-50, 2005. https://doi.org/10.1007/s00064-005-1120-8
  19. Rouleau DM, Laflamme GY, Berry GK, Harvey EJ, Delisle J, Girard J: Proximal humerus fractures treated by percutaneous locking plate internal fixation. Orthop Traumatol Surg Res, 95: 56-62, 2009. https://doi.org/10.1016/j.otsr.2008.09.003
  20. Smith J, Berry G, Laflamme Y, et al.: Percutaneous insertion of a proximal humeral locking plate: An anatomic study. Injury, 38: 206-211, 2007. https://doi.org/10.1016/j.injury.2006.08.025
  21. Tae SK, Rhee YG, Park TS, et al.: The development and validation of an appraisal method for the rotator cuff disorder: The Korean Shoulder Scoring System. J Shoulder Elbow Surg, 18: 689-696, 2009. https://doi.org/10.1016/j.jse.2008.11.019
  22. Acklin YP, Jenni R, Walliser M, Sommer C: Minimal invasive PHILOS plate osteosynthesis in proximal humeral fractures. Eur J Trauma Emerg Surg, 35: 35-39, 2009. https://doi.org/10.1007/s00068-008-7154-5

Cited by

  1. Operative Treatment of Displaced Proximal Humerus Fractures with the Angular Stable Locking Compression Plate vol.14, pp.1, 2011, https://doi.org/10.5397/CiSE.2011.14.1.027
  2. Internal Fixation of Proximal Humerus Fracture with Polyaxial Angular Stable Locking Compression Plate in Patients Older Than 65 Years vol.15, pp.1, 2012, https://doi.org/10.5397/CiSE.2012.15.1.25
  3. Minimally Invasive Plate Osteosynthesis for Humeral Proximal or Distal Shaft Fractures Using a 3.5/5.0 Metaphyseal Locking Plate vol.25, pp.4, 2012, https://doi.org/10.12671/jkfs.2012.25.4.305
  4. Comparison Study of Different Approach (Deltoid Splitting Approach and Delto-pectoral Interval Approach) for Proximal Humeral Fractures vol.16, pp.1, 2013, https://doi.org/10.5397/CiSE.2013.16.1.17