ASSESSMENT OF THE TREATMENT EFFICACY OF LOCKING COMPRESSION PLATES IN HUMERUS SHAFT FRACTURES

Year 2016, , 12 - 18, 30.04.2016

Erkan Akgün Ahmet Onur Akpolat İsmail Burak Atalay Uğur Tiftikçi Mehmet Eren Tuğrul Yıldırım

https://doi.org/10.24938/kutfd.252664

Abstract

Introduction: In this study, we evaluated the efficacy of osteosynthesis by using locking plate in the treatment of humerus shaft fractures.

Material and Methods: The mean age of 30 patients (19 male, 11 female) operated for humerus shaft fractures was 36.2 (23-66) years. A 3.5 locking compression plate was applied to all patients. We found radial nerve damage in 4 patients preoperatively. These lesions were considered neuropraxia and a dynamic splint was applied in order to keep wrist and fingers in extension after operation. Functional evaluation based on Stewart-Hundley criteria. The mean follow up period was 32 months (12-60 months).

Results: Except 1 patient, all patients showed radiological healing in 14 weeks on average (10 week-24 week). Two patients showed union retardation, and the mean union time of these patients was 21 weeks. These were class C1 fractures with larger soft tissue damage and multifragments. One patient developed pseudoarthrosis. Besides primary surgery, this patient underwent a pseudoarthrosis surgery with plate-screw and iliac grafting. Radiological union was achieved at the 18th week. Four patients with preoperative radial nerve damage underwent early radial nerve exploration and plate-screw fixation. Then, dynamic wrist splint was applied. All of them healed in 4 months. Based on Stewart-Hundley criteria, the result was good in 27 (90%) cases, moderate in 2 (6.6%) patients, and bad in 1 (3.3%) patient. Radial nerve damage due to surgery occurred in 1 patient who achieved full recovery 3 months after surgery. A superficial skin infection was developed in 1 patient and it was managed with oral antibiotic therapy. None of the patients developed deep soft tissue infection which requires removal of the implant.

Conclusion: In the treatment of humerus shaft fractures, osteosynthesis with locking plate may result in satisfactory radiologic and functional outcomes providing sufficient fixation and early mobilization when used with correct technique in adequate patient.

Keywords

Locking plate, humerus fracture, fracture fixation

Humerus Cisim Kırıklarının Kilitli Kompresyon Plakları ile Tedavi Etkinliğinin Değerlendirmesi

Abstract

Giriş: Bu çalışmamızda, humerus
cisim kırıklarının tedavisinde uyguladığımız kilitli plak ile osteosentezin
etkinliğini değerlendirdik.Gereç ve Yöntem: Humerus cisim kırığı
nedeniyle opere edilen 30 hastanın (19 erkek, 11 kadın) ortalama yaşı 36,2 yıl
(23-66 yıl) idi. Tüm hastalara 3,5’luk kilitli kompresyon plağı ile osteosentez
uygulandı. 4 hastamızda preop radial sinir arazı saptandı. Nöropraksi olarak
değerlendirilen bu lezyonlara cerrahi bir işlem yapılmayıp postoperatif el
bileği ve parmakları ekstansiyonda tutan dinamik splint uygulandı. Fonksiyonel
sonuçlar Stewart-Hundley ölçütlerine göre değerlendirildi. Hastaların ortalama
takip süresi ortalama 32 ay (12-60 ay) idi.Bulgular: Bir hasta dışında tüm
hastalarımızda ortalama 14 haftada (10-24 hafta) radyolojik iyileşme sağlandı.
İki hastamızda kaynama gecikmesi saptandı, bu hastaların ortalama kaynama
süresi 21 hafta olarak tespit edildi, AO sınıflamasına göre parçalı ve yumuşak
doku hasarının fazla olduğu C1 sınıfı kırıklar idi. Bir hastamızda psödoartoz
gelişti. Bu hastaya primer cerrahi dışında iliak kanattan alınan greft ile
beraber plak-vida ile psödoartroz cerrahisi yapıldı. 18. haftada radyolojik
olarak kaynama sağlandı. Preop radial sinir arazı olan 4 olguya erken radial
sinir eksprolasyonu ve plak vida ile fiksasyon yapıldıktan sonra dinamik el
bileği splinti uygulandı ve tüm hastalarda 4 ay içinde tam düzelme sağlandı. Stewart-Hundley
ölçütlerine göre 27 olguda (%90) iyi, 2’sinde (%6,6) orta, 1’inde (%3,3) kötü
sonuç elde edildi. Bir olgumuzda cerrahi operasyona bağlı olarak radial sinir
arazı gelişti ve cerrahi sonrası üçüncü ayda tam düzelme sağlandı. Bir olguda
oral antibiyotik tedavisi ile düzelen yüzeyel cilt enfeksiyonu gelişti. Hiç bir
olgumuzda implant çıkarmayı gerektirecek derin yumuşak doku enfeksiyonuna
rastlanmadı.
Sonuç: Humerus cisim kırıklarının
tedavisinde kilitli plak osteosentez ile uygun hasta ve doğru teknik
kullanıldığında, yeterli fiksasyon ve erken hareket sağlanmakta, tatmin edici
radyolojik ve fonksiyonel sonuç alınmaktadır.

Keywords

Kilitli plak, humerus kırığı, kırık tespiti

References

• Nayak NK, Schickendantz MS, Regan WD, Hawkins RJ. Operative treatment of nonunion of surgical neck fractures of the humerus. Clin Orthop Relat Res. 1995; 313: 200-5.
• Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvist H, Ponzer S. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg Br. 2006; 88(11): 1469- 73.
• Modabber MR, Jupiter JB. Operative management of diaphyseal fractures of the humerus. Plate versus nail. Clin Orthop Relat Res. 1998; 347: 93-104.
• Arpacioğlu MO, Pehlivan O, Akmaz I, Kiral A, Oğuz Y. Interlocking intramedullary nailing of humeral shaft fractures in adults. Acta Orthop Traumatol Turc. 2003; 37(1): 19-25.
• Foster RJ, Dixon GL Jr, Bach AW, Appleyard RW, Green TM. Internal fixation of fractures and non- unions of the humeral shaft. Indications and results in a multi-center study. J Bone Joint Surg Am. 1985; 67(6): 857-64.
• Sarmiento A, Waddell JP, Latta LL. Diaphyseal humeral fractures: treatment options. Instr Course Lect. 2002; 51: 257-69.
• Öztürk K, Aksoy B, Okay E, Yıldırım ÖS, Esenyel ES, Kara AN. Humerus cisim kırıklarının plak vida osteosentezi ile tedavisi. Acta Orthop Traumatol Turc. 1999; 33: 121-5.
• Dağlar B, Delialioğlu OM, Taşpaş BA, Bayrakçi K, Ağar M, Günel U. Comparison of plate-screw fixation and intramedullary fixation with inflatable nails in the treatment of acute humeral shaft fractures. Acta Orthop Traumatol Turc. 2007; 41(1): 7-14.
• Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. J Bone Joint Surg Br. 1998; 80(2): 249-53.
• Caldwell JA. Treatment of Fractures in the Cincinnati General Hospital. Ann Surg. 1933; 97(2): 161-76.
• Charles A, Rockwood Jr, David PG, Robert WB, James DH. Rockwood and Green’s Fractures in Adults. Lippincott-Raven. 1996.
• Zagorski JB, Latta LL, Zych GA, Finnieston AR. Diaphyseal fractures of the humerus. Treatment with prefabricated braces. J Bone Joint Surg Am. 1988; 70(4): 607-10.
• Seligson D, Ostermann PA, Henry SL, Wolley T. The management of open fractures associated with arterial injury requiring vascular repair. J Trauma. 1994; 37(6): 938-40.
• Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nevre palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. 2005; 87(12): 1647- 52.
• Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am. 2000; 82(4): 478-86.
• Hunter SG. The closed treatment of fractures of the humeral shaft. Clin Orthop Relat Res. 1982; 164: 192-8.
• L. Klenerman. Fractures of the shaft of the humerus. J Bone Joint Surg Am. 1990; 72: 701-7.
• Christensen S. Humeral shaft fractures, operative and conservative treatment. Acta Chir Scand. 1967; 133(6): 455-60.
• Böstman O, Bakalim G, Vainionpaa S, Wilppula E, Patiala H, Rokkanen P. Radial palsy in shaft fracture of the humerus. Acta Orthop Scand. 1986; 57(4): 316-9.
• Kettelkamp DB, Alexander H. Clinical review of radial nerve injury. J Trauma 1967; 7(3):424–32.
• Kesemenli CC, Subaşi M, Arslan H, Necmioğlu S, Kapukaya A. Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures. Acta Orthop Traumatol Turc 2003; 37(2): 120-5.
• Flinkkila T, Hyvönen P, Lakovaara M, Linden T, Ristiniemi J, Hamalainen M. Intramedullary nailing of humeral shaft fractures. A retrospective study of 126 cases. Acta Orthop Scand 1999; 70(2): 133-6.
• Robinson CM, Bell KM, Court-Brown CM, McQueen MM. Locked nailing of humeral shaft fractures. Experience in Edinburgh over a two-year period. J Bone Joint Surg Br. 1992; 74(4): 558-62.
• Stern PJ, Mattingly DA, Pomeroy DL, Zenni EJ Jr, Kreig JK. Intramedullary fixation of humeral shaft fractures. J Bone Joint Surg Am. 1984; 66(5): 639- 46.
• Riemer BL, Butterfield SL, D'Ambrosia R, and Kellam J. Seidel intramedullary nailing of humeral diaphyseal fractures: a preliminary report. Orthopedics. 1991; 14(3): 239-46.
• Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft fractures in patient with multiple injuries. The Sunnybrook experience. J Bone Joint Surg Br. 1985; 67(2): 293- 6.
• H Bekler, Bulut G, Usta M, Gökçe A, Okyar F, Beyzadeoğlu T. The contribution of locked screw- plate fixation with varying angle configurations to stability of osteoporotic fractures: an experimental study. Acta Orthop Traumatol Turc. 2008; 42(2): 125-9.
• Jiang R, Luo CF, Zeng BF, Mei GH. Minimally invasive plating for complex humeral shaft fractures. Arch Orthop Trauma Surg. 2007; 127(7): 531-5.
• Aksu N, Göğüş A, Kara AN, Işiklar ZU. Complications encountered in proximal humerus fractures treated with locking plate fixation. Acta Orthop Traumatol Turc. 2010; 44(2): 89-96.
• Will R, Englund R, Lubahn J, Cooney TE. Locking plates have increased torsional stiffness compared to standard plates in a segmental defect model of clavicle fracture. Arch Orthop Trauma Surg. 2011; 131(6): 841-7.