Results of surgical management of valgus-impacted proximal humerus fractures with structural allografts

Year 2014, Volume: 48 Issue: 5, 546 - 552, 12.11.2014

Ata Atalar İlker Eren Serkan Uludag Mehmet Demirhan

https://doi.org/10.3944/AOTT.2014.14.0115

Abstract

Objective: The aim of this study was to clinically and radiologically evaluate patients treated with plate osteosynthesis with structural allografts for severely valgus-impacted fractures of the proximal humerus.

Methods: The study included 10 patients (average age: 57 years; range: 34 to 77 years) with valgus-impacted Neer Type 4 proximal humerus fractures. Fractures were classified according to the Robinson classification. Patients were called for an up-to-date examination and evaluated radiologically and clinically with Constant and DASH scores.

Results: Average follow-up period was 22.5±12.2 (range: 12 to 50) months. Average DASH score at the final follow-up was 7.6±4.5 (range: 2.5 to 16.7) and average Constant score was 87.7±4.4 (range: 83 to 94). None of the cases had early or late head collapse. There was no avascular necrosis. One early screw penetration was observed.

Conclusion: Surgical treatment of valgus-impacted proximal humerus fractures achieved successful results. However, the cavity under the humeral head may lead to failure due to mechanical insufficiency. Plate osteosynthesis with structural allografts warrants initial mechanical support until union, thus avoiding complications related to head collapse.

Keywords

Proximal humerus fracture, structural allograft, valgus impaction

Valgus impakte proksimal humerus kırıklarında yapısal allogreft ile tedavi sonuçları

Abstract

Amaç: Bu çalışmada yapısal allogreftlerle yapılan plak osteosentezi ile ileri derecede valgus impakte kırıkları üzerinde alınacak sonuçların klinik ve radyolojik açıdan değerlendirilmesi amaçlanmıştır.

Çalışma planı: Valgus impakte Neer Tip 4 proksimal humerus kırığı tanısı alan ve ortalama yaşı 57 (dağılım: 34-77) olan 10 hasta çalışmaya dahil edilerek, kırıkları Robinson sınıflamasına göre sınıflandı. Hastalar güncel muayeneleri için çağrıldı; Constant ve DASH skorları ile klinik ve radyolojik olarak değerlendirildiler.

Bulgular: Ortalama takip süresi 22.5±12.2 (dağılım: 12-50) ay olarak kaydedildi. Son kontrol sırasında ortalama DASH skoru 7.6±4.5 (dağılım: 2.5-16.7) ve Constant skoru 87.7±4.4 (dağılım: 83-94) olarak ölçüldü. Hastaların hiçbirinde erken ve geç baş çökmesi veya avasküler nekroz görülmedi. Bir hastada erken vida penetrasyonu saptandı.

Çıkarımlar: Valgus impakte kırıkların cerrahi tedavisi ile başarılı sonuçlar elde edilmiştir. Bununla birlikte, humerus başının altında ortaya çıkan kavite, mekanik yetersizlik nedeniyle başarısızlığa yol açabilir. Yapısal allogreftler ile yapılan plak osteosentezi, başlangıç aşamasından kaynamaya dek yeterli mekanik desteği sağlayarak, baş çökmesi ile ilişkili komplikasyonlar oluşmasına engel olmaktadır.

Keywords

Proksimal humerus kırığı; valgus impaksiyonu; yapısal allogreft

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