Orthopaedics & traumatology, surgery & research : OTSR · 2012
Is it worth fixing proximal humeral fractures at increased vascular risk?
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Thomazeau H, Richou J, Benkalfalte T, Kerhousse G, Le Nen D, Veillard D
Аннотация
OBJECTIVE: To evaluate fixation of proximal humeral fractures by anterograde nailing, in terms of fracture reduction, bone healing; osteonecrosis; functional consequences of osteonecrosis and malunion.
DESIGN: Prospective, consecutive, multicenter based.
SETTING: Academic Trauma Centers; approval was received from the ethics committee of the institutions involved in the study.
METHODS: Fifty-one patients were enrolled prospectively, with 31 3-part and 20 4-part displaced fractures (head displacement greater than 45°, tuberosity-head gap greater than 10mm, diaphyseal gap greater than 10mm). A Telegraph™ nail (FH Orthopedics, Heimsbrunn, France) was the fixation device used, introduced through a superolateral transdeltoid approach under fluoroscopic guidance. The assessment included Simple Shoulder Test, absolute Constant score, X-rays every 3 months and CT-scan at final evaluation. Twelve patients died and one was lost to follow-up. Immediate complications included secondary displacement in four patients.
RESULTS: There were no infections, no deltoid muscle or axillary nerve damage, and all the fractures united. After a mean follow-up of 24.1 months, malunion was observed in 29% of the remaining 38 patients and osteonecrosis in 32%. Both complications were more frequent and extensive in patients with 4-part fractures. The osteonecrosis area influenced the Constant score, which was 55.8 points when the area was less than 30%, 50.6 points between 30 and 50%, and 38 points when larger than 50%. Head malunion affected the Simple Shoulder Test and the Constant score.
CONCLUSION: Nailing may thus be recommended for 3-part fractures, because osteonecrosis is less frequent, more focused, and better tolerated in this sub-group. In contrast, antegrade nailing was not more beneficial than other internal fixation techniques for preventing osteonecrosis or head malunion in patients with 4-part fractures.
LEVEL OF EVIDENCE: Level IV: prospective study.
DESIGN: Prospective, consecutive, multicenter based.
SETTING: Academic Trauma Centers; approval was received from the ethics committee of the institutions involved in the study.
METHODS: Fifty-one patients were enrolled prospectively, with 31 3-part and 20 4-part displaced fractures (head displacement greater than 45°, tuberosity-head gap greater than 10mm, diaphyseal gap greater than 10mm). A Telegraph™ nail (FH Orthopedics, Heimsbrunn, France) was the fixation device used, introduced through a superolateral transdeltoid approach under fluoroscopic guidance. The assessment included Simple Shoulder Test, absolute Constant score, X-rays every 3 months and CT-scan at final evaluation. Twelve patients died and one was lost to follow-up. Immediate complications included secondary displacement in four patients.
RESULTS: There were no infections, no deltoid muscle or axillary nerve damage, and all the fractures united. After a mean follow-up of 24.1 months, malunion was observed in 29% of the remaining 38 patients and osteonecrosis in 32%. Both complications were more frequent and extensive in patients with 4-part fractures. The osteonecrosis area influenced the Constant score, which was 55.8 points when the area was less than 30%, 50.6 points between 30 and 50%, and 38 points when larger than 50%. Head malunion affected the Simple Shoulder Test and the Constant score.
CONCLUSION: Nailing may thus be recommended for 3-part fractures, because osteonecrosis is less frequent, more focused, and better tolerated in this sub-group. In contrast, antegrade nailing was not more beneficial than other internal fixation techniques for preventing osteonecrosis or head malunion in patients with 4-part fractures.
LEVEL OF EVIDENCE: Level IV: prospective study.
Предметные рубрики MeSH
AdolescentAdultAgedAged, 80 and overBone NailsFemaleFluoroscopyFracture Fixation, InternalFractures, MalunitedHumansMaleMiddle AgedOsteonecrosisPostoperative ComplicationsProspective StudiesShoulder FracturesStatistics, NonparametricTomography, X-Ray ComputedTreatment OutcomeVascular System Injuries