İzole humerus tüberkulum majus kırıklarında tedavi sonuçları [Treatment results in isolated humerus majus fractures]

Year 2012, Volume: 3 Issue: 3, 378 - 382, 01.09.2012

Hakan Serhat Yanık Mehmet Kerem Canbora Atilla Polat Hasan Bombacı Şevki Erdem Abdullah Demirtaş

https://doi.org/10.5799/ahinjs.01.2012.03.0182

Abstract

Introduction: The aim of this study is to evaluate the results of patients with the isolated greater tubercul fractures (GTF) of humerus who conservatively or surgically treated. Materials and methods: 23 patients were admitted (11 women, 12 men) with GTF (54% dominant side of 24 shoulder) between 2008 and 2011. All of patient were evaluated with MRI as preoperatively soft tissue injury. There was supraspinatus muscle tear together with GTF in 3 case and their shoulder were arthroscopically assisted rotator cuff repair. Osteosynthesis was performed in 3 case with screw and fixation in 2 case with suture. GTF of 16 shoulder were conservatively treated. Shoulder function after treatment were evaluated according to Constant score (CS), Quick-DASH score (QDS) and VAS score. Results: Three patients with screw fixation had CS 68,6 points, QDS 12,8 points, VAS score 1,66. Two patients with suture fixation had 67,5 CS points, 5,1 QDS pointsp, and 2 VAS score. Three patients with rotator cuff tear repair had 82,6 CS points, 16,6 QDS points, and 2,33 VAS score. In patients with conservatively treated mean CS was 63,9 points, QDS 26,1 points, VAS 2,96 points. Conclusions: In this study, conservative and surgical treatment results were satisfactory. In terms of pain the results were excellent. In conclusion, GTFs are rare but trouble-free with a good observation and sufficient rehabilitation.

Keywords

Humerus, fracture, greater, tubercul

İzole humerus tüberkulum majus kırıklarında tedavi sonuçları

Abstract

Amaç: Bu çalışmanın amacı, izole humerus tüberkulum majus kırığı (TMK) bulunan hastaların konservatif ve cerrahi tedavi sonuçlarını değerlendirmektir. Gereç ve yöntem: 2008-2011 yılları arasında kliniğimize başvuran ve TMK bulunan 23 olgu (11 kadın, 12 erkek)\'nun 24 omuzu (% 54 dominant) çalışmaya dahil edildi. Tüm olguların travma sonrası MR görüntüleri ile yumuşak doku patolojileri değerlendirildi. Üç olguda TMK\'ya eşlik eden supraspinatus yırtığı tespit edildi. Kırıkla birlikte supraspinatus yırtığı tespit edilen üç olguya osteosentez yapılmaksızın rotator manşet onarımı yapıldı. Üç olguda vida ile osteosentez, iki olguda sutur (ethibond) ile kırık tespit edildi. Onbeş olgunun on altı omuzu konservatif yöntemle tedavi edildi. Tedavi sonrası omuz fonksiyonlarının değerlendirilmesinde Constant skorlaması (CS), Quick- Dash skorlaması (QDS) ve Görsel Analog Skala (VAS) kullanıldı. Bulgular: Vida ile osteosentez yapılan üç olgunun ortalama CS puanı 68,6, QDS puanı 12,8 ve VAS değerleri 1,66 olarak bulundu. TMK\' nın sutur ile yerine dikildiği iki olgunun CS puanı 67,5, Quick-DASH skoru 5,7 ve VAS değerleri 2 olarak bulundu. Rotator manşet yırtığı onarımı yapılan üç olgunun Constant skoru 82,6, Quick-DASH skoru 16,6 ve VAS değerleri 2,33 olarak tespit edildi. Konservatif olarak tedavi edilen 16 olgunun CS puanı 63,9, QDS puanı 26,1 ve VAS değerleri 2,96 puan olarak bulundu. Sonuç: Çalışmamızda konservatif ve cerrahi tedavi uygulanan olgularımızın fonksiyonel sonuçları tatminkar bulundu. Ağrı açısından sonuçlarımız ise mükemmel bulunmuştur. Sonuç olarak TMK\'lar nadir görülen, yakın takip ve yeterli rehabilitasyonla sorunsuz iyileşen yaralanmalardır.

Keywords

Humerus, kırık, majus, tüberkul

References

• Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tu- berosity fractures of the proximal humeral: Current concepts. Injury 2008; 39(2): 284-14.
• Gumina S, Carbone S, Postacchini F. Occult fractures of the greater tuberosity of the humerus. Int Orthop 2009;33(1):171-4.
• Neer CS. Displaced proximal humeral fractures. Part 1. Classification and evaluation. J Bone Joint Surg (Am) 1970; 52(6):1077-11.
• Platzer P, Kutscha-Lissberg F, Lehr S, et al. The influ- ence of displacement on shoulder function in patients with minimally displaced fractures of the greater tu- berosity. Injury 2005; 36(1): 1185-4.
• Williams GR, Wong KL. Two-part and three-part frac- tures: open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am 2000; 31(1):1-21.
• Constant CR, Murley AH. A clinical method of func- tional assesment of the shoulder. Clin Orthop Rel Res 1987;214(2):160-4.
• Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of three item-reduction ap- proaches. J Bone Joint Surg Am 2005;87(5):1038-8.
• Johnson JR, Bayley JIL. Early complications of acute anterior dislocation of the shoulder in the middle-aged and elderly patient. Injury 1982; 13(5):431-4.
• Park TS, Choi IY, Kim YH, Park MR, Shon JH, KimSI .A new suggestion for the treatment of minimally dis- placed fractures of the greater tuberosity of the proksi- mal humerus. Bull Hosp Jt Dis 1997; 56(3):171-6.
• Böhler J. Resent fractures of the shoulder. Acta Or- thop Belgica 1964; 30(2):235-7.
• De Palma AF, Cautilli RA. Fractures of the upper end of the humerus. Clin Orthop 1961; 20(1):73-6.
• Neviaser J. Complicated fractures and dislocations about the shoulder joint. J Bone Joint Surg (Am) 1962;984-4.
• McLauglin HL. Dislocation of the shoulder with tuber- osity fracture. Surg Clin North Am 1963;43(12):1615- 5.
• Green A, Norris T. Complications of non-operative management and internal fixation of proximal humer- us fractures. In: Flatow E, Ulrich C, editors. Musculo- skeletal trauma series-humerus. Oxford: Butterworth- Heineman; 1996.p.106-20.
• Flatow EL, Cuomo F, Maday MG, Miller SR, Mcllveen SJ, Bigliani LU. Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. J Bone Joint Surg Am 1991; 73(8):1213-5.
• Park MC, Murthi AM, Roth NS, Blaine TA, Levine WN, Bigliani LU. Two-part and three-part fractures of the proximal humerus treated with suture fixation. J Or- thop Trauma 2003; 17(5):319-6.
• Gartsman GM, Taverna E, Hammerman SM. ar- throscopic treatment of acute traumatic anterior gle- nohumeral dislocation and greater tuberosity fracture. Arthroscopy 1999; 15(6):648-2.
• Paavolainen P, Bjorkenheim JM, Slatis P, Paukku P. Operative treatment of severe proximal humeral frac- tures. Acta Orthop Scand 1983; 54(3):374-5.
• Platzer P, Thalhammer G, Oberleitner G, et al. Dis- placed fractures of the greater tuberosity: A compari- son of operative and nonoperative treatment. J Trau- ma 2008; 65(4): 843-5.
• Carrera EF, Matsumoto MH, Archetti Netto NA, Falop- pa F. Fixation of greater tuberosity fractures. Arthros- copy 2004; 20(8):109-2.
• Rasmussen S, Hvass I, Dalsgaard J, Christensen BS, Holstad E. Displaced proximal humeral fractures: re- sults of conservative treatment. Injury 1992; 23(1):41- 2.
• Leffert RD, Seddon H. Infraclavicular brachial plexus injuries. J Bone Joint Surg Br 1965; 47(1):9-22.
• Toolanen G, Hildingsson C, Hedlund T, Knibestöl M, Oberg L. Early complications after anterior dislocation of the shoulder in patients over 40 years. Acta Orthop Scand 1993; 64(5):549-2.
• Kim SH, Ha KI. Arthroscopic treatment of symptom- atic shoulders with minimally displaced greater tuber- osity fracture. Arthroscopy 2000; 16(7):695-5.
• Keene JS, Huizenga RE, Engber WD, et al. Proximal humerus fractures. A correlation of residual deformity with long-term function. Orthopaedics 1983; 6(2):173- 8.