Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures

상완골 간부 골절에서 교합성 골수강 내 금속정 고정 후 잔존한 골절편 전위에 대한 임상적, 방사선학적 추시

  • Yum, Jae-Kwang (Department of Orthopaedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University) ;
  • Lim, Dong-Ju (Department of Orthopaedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University) ;
  • Jung, Eui-Yub (Department of Orthopaedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University) ;
  • Sohn, Su-Een (Department of Orthopaedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University)
  • 염재광 (인제대학교 의과대학 상계백병원 정형외과학교실) ;
  • 임동주 (인제대학교 의과대학 상계백병원 정형외과학교실) ;
  • 정의엽 (인제대학교 의과대학 상계백병원 정형외과학교실) ;
  • 손수인 (인제대학교 의과대학 상계백병원 정형외과학교실)
  • Received : 2013.04.04
  • Accepted : 2013.09.30
  • Published : 2013.12.31
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Abstract

Purpose: This study is designed to evaluate the clinical and radiographical results for the displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures. Materials and Methods: We retrospectively reviewed the results of 8 cases of humeral shaft fractures that have displacements of over 10 mm and under 20 mm after interlocking intramedullary nailing between July 2004 and August 2011. The mean age was 54.1 years (range, 43 to 70 years) and there were 3 male and 5 female patients. Radiographically, the time to bony union, change of displacement and angulation of the fracture site, and degree of improvement of these two factors were measured. Clinically, the range of motion of shoulder and elbow joints, postoperative pain and complications were evaluated. Results: All cases showed complete bony union in last follow-up. The mean time to bony union was 16.1 weeks. At the last follow-up, almost all cases had normal range of motion of shoulder and elbow joints. But, one case had stiffness of shoulder joint. Therefore, arthroscopic capsular release and manipulation was performed. One case had transient shoulder pain and the other case had transient elbow pain. In the two cases, pull-out of proximal interlocking screw were noted, but they finally had bony union. Conclusion: Although considerable displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures was present, we had excellent radiographical and clinical outcomes. Therefore, an additional procedure, such as open reduction or another fixation for the fracture site, was not necessary.

목적: 상완골 간부 골절에서 골수강 내 금속정 고정을 시행한 후 잔존한 전위에 대해 임상적, 방사선학적 결과를 분석하였다. 대상 및 방법: 2004년 7월부터 2011년 8월까지 상완골 간부 골절에 대해서 골수강 내 금속정 고정 후 잔존한 전위가 10 mm 이상, 20 mm 미만인 8예를 대상으로 하였다. 평균 연령은 54.1세(43~70세), 남자 3예, 여자 5예였다. 수술 직후 단순 방사선 사진으로 전위와 각형성의 정도를 측정하였으며, 추시 방사선 사진으로 이의 호전 정도와 골유합, 합병증 여부를 확인하였다. 술 후 견관절 및 주관절의 운동 범위와 통증에 대해서 조사하였다. 결과: 모든 예에서 골유합을 얻을 수 있었고, 평균 골유합 기간은 16.1주였다. 최종 추시 견관절 및 주관절의 운동범위는 대부분 정상 범위로 돌아왔다. 1예에서 견관절 강직으로 인하여 관절경적 관절낭 이완술 및 도수 조작술 후 운동범위를 회복하였으며, 일시적인 견관절 통증 1예, 주관절 통증 1예가 있었다. 2예에서 근위 나사못의 빠짐이 있었으나 모두 골유합을 얻었다. 결론: 상완골 간부 골절에서 골수강 내 금속정 고정 후 잔존한 전위에도 불구하고 골유합을 얻을 수 있었으며 우수한 임상적 결과를 보였기 때문에, 관혈적 정복 또는 추가 고정은 필요하지 않았다.

Keywords

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