Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Operative Treatment of Displaced Proximal Humerus Fractures with the Angular Stable Locking Compression Plate

각안정 잠김 압박 금속판을 이용한 전위된 근위 상완골 골절에 대한 수술적 치료

  • Kim, Dong-Wook (Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University) ;
  • Kim, Chong-Kwan (Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University) ;
  • Jung, Sung-Won (Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University) ;
  • Kim, Hyeon-Soo (Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University)
  • 김동욱 (성균관대학교 삼성창원병원 정형외과학교실) ;
  • 김종관 (성균관대학교 삼성창원병원 정형외과학교실) ;
  • 정성원 (성균관대학교 삼성창원병원 정형외과학교실) ;
  • 김현수 (성균관대학교 삼성창원병원 정형외과학교실)
  • Received : 2011.04.22
  • Accepted : 2011.06.01
  • Published : 2011.06.30
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Abstract

Purpose: We examined the clinical and radiological outcomes for displaced proximal humerus fractures that were treated with a PHILOS angular stable plate. Materials and Method: Forty four patients who underwent surgery between March 2007 and February 2010 were included in this study. All the cases were followed up for an average of 12 months. All the patients were examined and interviewed using the Visual Analog Scale (VAS) score, the Constant score and standardized X-rays to check the neck-shaft angle (NSA) and the presence of medial support. Results: The average Visual Analog Scale score was 2.8 points and the average Constant score was 70.5 points. The average neck shaft angle was $122.5^{\circ}$ and this was statistically significant between the good result group and the poor result group. There were 36 cases of the presence of medial support and 8 cases of the absence of medial support and the difference was statistically significant. Complications such as fixation failure happened in 12 cases. Conclusion: PHILOS angular stable plate fixation as an operative treatment for displaced proximal humerus fractures is a good and reliable treatment option.

목적: 전위된 근위 상완골 골절에 대하여 PHILOS 각안정 잠김 압박 금속판을 이용한 수술적 치료 후 임상적 및 방사선학적 결과와 합병증에 대하여 알아보고자 하였다. 대상 및 방법: 2007년 3월부터 2010년 2월까지 근위 상완골 골절로 PHILOS 금속판 고정술을 시행한 44명의 환자를 대상으로, 평균 12개월의 추시 관찰을 시행하였다. 임상적 평가는 VAS 점수와 Constant 점수를 이용하였으며, 방사선학적 평가는 단순 방사선 검사 상 경간각과 내측지지대의 존재 유무로 평가하였다. 결과: 최종 추시에서 평균 VAS 점수는 2.8점, Constant 점수는 평균 70.5점이었으며, 방사선학적 평가 결과 평균 경간각 122.5도로 양호군은 불량군에 비해 통계적으로 유의한 소견을 보였다. 내측 지지대가 존재하는 경우 36예 또한 존재하지 않는 8예에 비해 통계적으로 유의하였다. 12예에서 금속판의 고정 실패 등의 합병증이 관찰되었다. 결론: PHILOS 금속판을 이용한 전위된 근위 상완골 골절 고정술은 술기가 용이하고 만족할 만한 결과를 얻을 수 있다고 생각된다.

Keywords

References

  1. De palma AF. Surgery of the shoulder. 3rd ed, Philadelphia, JB Lippincontt Co. 1983;372-406.
  2. Louis UB. Fractures of the proximal humerus. In: Rockwood. C.A. Jr and Masten, F.A. III ed. The shoulder. 1st Ed. Philadelphia, W.B. Saunders Co. 1990; 287-334.
  3. Robert HC. Comminuted fractures of the proximal humerus. Clin Orthop Relat Res. 1986;210:49-57.
  4. Lill H, Hepp P, Korner J, et al. Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human sepcimens. Arch Orthop Trauma Surg. 2003;123:74-81.
  5. Bogner R, Hu¨bner C, Matis N, Auffarth A, Lederer S, Resch H. Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. Bone Joint Surg Br. 2008;90:1602-7. https://doi.org/10.1302/0301-620X.90B12.20269
  6. Kobayashi M, Watanabe Y, Matsushita T. Early full range of shoulder and elbow motion is possible after minimally invasive plate osteosynthesis for humeral shaft fractures. J Orthop Trauma. 2010;24:212-6. https://doi.org/10.1097/BOT.0b013e3181c2fe49
  7. Park CH, Park SH, Seo JS. Internal fixation of proximal humerus fracture with locking compression plate. J Korean Shoulder Elbow Soc. 2009;12:44-52. https://doi.org/10.5397/CiSE.2009.12.1.044
  8. Ha SS, Kim JY, Hong KD, Sim JC, Kang JH, Park KH. Operative Treatment with Locking Compression Plate (LCP) in Proximal Humerus Fracture. J Korean Shoulder Elbow Soc. 2008;11:137-42. https://doi.org/10.5397/CiSE.2008.11.2.137
  9. Kristiansen B, Christensen SW. Plate fixation for displaced proximal humeral fractures. Acta Orthop Scand. 1986;57:320-3. https://doi.org/10.3109/17453678608994401
  10. Frigg R. Development of the locking compression plate, Injury. 2003;34:6-10. https://doi.org/10.1016/j.injury.2003.09.020
  11. Ha SS, Kim JY, Hong KD, et al. Treatment of Twoand Three-Part Fracture of Proximal Humerus using LCP. J Korean Shoulder Elbow Soc. 2007;10:204-11. https://doi.org/10.5397/CiSE.2007.10.2.204
  12. Neer CS II. Displaced proximal humeral fractures: classification and evaluation. J Bone Joint Surg Am. 1970;52:1077-89.
  13. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-4.
  14. Paavolainen P, Bjo¨rkenheim JM, Sla¨tis P, Paukku P. Operative treatment of severe proximal humerus fractures. Acta Orthop Scand. 1983;54:374-9. https://doi.org/10.3109/17453678308996587
  15. Gardner MJ, Griffith MH, Lorich DG. Helical plating of the proximal humerus. Injury. 2005;36:1197-200. https://doi.org/10.1016/j.injury.2005.06.038
  16. Gardner MJ, Weil Y, Baker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21:185-91. https://doi.org/10.1097/BOT.0b013e3180333094
  17. 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. https://doi.org/10.2106/JBJS.H.00133
  18. Bjorkenheim 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. https://doi.org/10.1080/00016470410004120
  19. Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. Treatment of proximal humeral fractures with the PHILOS angular stable plate: Presentation of 225 cases of dislocated fractures. Unfallchirurg. 2006;109:1032-40. https://doi.org/10.1007/s00113-006-1165-7
  20. Agudelo J, Schu¨rmann 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. https://doi.org/10.1097/BOT.0b013e31815bb09d
  21. Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg. 2009;18:837-44. https://doi.org/10.1016/j.jse.2009.06.004
  22. Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011;42:408-13. https://doi.org/10.1016/j.injury.2010.11.058
  23. Roderer G, Erhardt J, Graf M, Kinzl L, Gebhard F. Clinical results for minimally invasive locked plating of proximal humerus fractures. J Orthop Trauma. 2010; 24:400-6. https://doi.org/10.1097/BOT.0b013e3181ccafb3
  24. Rouleau DM, Laflamme GY, Berry GK. Proximal humerus fractures treated by percutaneous locking plate internal fixation. Orthop Traumatol Surg Res. 2009;95:56-62. https://doi.org/10.1016/j.otsr.2008.09.003
  25. Rancan M, Dietrich M, Lamdark T, Can U, Platz A. Minimal invasive long $PHILOS(^{(R)})$-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus. Injury. 2010;41:1277-83. https://doi.org/10.1016/j.injury.2010.07.235
  26. Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011;1:17-22.
  27. Resch H, Hu¨bner C, Schwaiger R. Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head. Injury. 2001;32:25-32. https://doi.org/10.1016/S0020-1383(01)00058-4
  28. Smith J, Berry G, Laflamme Y, Blain-Pare E, Reindl R, Harvey E. Percutaneous insertion of a proximal humeral locking plate: an anatomic study. Injury. 2007;38:206-11. https://doi.org/10.1016/j.injury.2006.08.025
  29. Shin SJ, Do NH, Song MH, Sohn HS. Minimal invasive plate osteosynthesis in proximal humerus fractures. J Korean Shoulder Elbow Soc. 2010;13:202-8. https://doi.org/10.5397/CiSE.2010.13.2.202
  30. Saran N, Bergeron SG, Benoit B, Reindl R, Harvey EJ, Berry GK. Risk of axillary nerve injury during percutaneous proximal humerus locking plate insertion using an external aiming guide. Injury. 2010;41:1037-40. https://doi.org/10.1016/j.injury.2010.04.014

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