Humerus cisim kırıklarında minimal invaziv perkütan plak osteosentezi (MIPPO)

Year 2022, Volume: 47 Issue: 2, 555 - 562, 30.06.2022

Buğra Kundakçı , Ömer Biçer , Gazi Huri , Mustafa Tekin , Melih Bağır , Mehmet Ali Deveci , Akif Mirioğlu

https://doi.org/10.17826/cumj.1030704

Abstract

Amaç: Kliniğimizde minimal invaziv perkütan plak osteosentezi (MIPPO) ile tedavi edilen humerus cisim kırıklarının radyolojik ve fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: MIPPO ile tedavi edilen 20 hastanın 21 humerus cisim kırığına ait verileri retrospektif olarak değerlendirildi. Hastaların demografik verileri, yaralanma şekilleri, AO sınıflaması ve bölgesine göre kırık sınıflaması, sigara kullanımı, radial sinir yaralanması kaydedildi. Radyografik olarak 6. ayda kaynama durumu ve dizilim değerlendirildi. Hastaların son kontrollerinde omuz ve dirsek hareket açıklığı ile objektif, Amerikan Omuz ve Dirsek Derneği (ASES) skoru, California Üniversitesi Los Angeles (UCLA) skoru, Mayo dirsek performans indeksi (MEPI), Kol Omuz El Engellilik (DASH) skoru ve Constant omuz skoru ile subjektif değerlendirme yapıldı.
Bulgular: Hastaların ortalama omuz fleksiyonu 169,5°±26,4°, abdüksiyonu 169,5°±26,4° idi. Ortalama dirsek hareket arkı 131,4°±19,8° bulundu. Ortalama ASES ve UCLA skorları sırasıyla 88,5±16,4 ve 32,1±5,2, MEPI ve DASH skoru sırasıyla 93,1±11,3 ve 11,8±20,0, ortalama Constant skoru 9,1±15,3 bulundu. İki hastada 6. ayda kaynamama gözlendi.
Sonuç: MIPPO yöntemi humerus cisim kırıklarının tedavisinde; minimal yumuşak doku hasarı, korunmuş omuz ve dirsek fonksiyonları ile başarılı bir tekniktir.

Keywords

Humerus kırıkları, Minimal invaziv cerrahi işlemler, Kırık sabitlemesi

Supporting Institution

yok

Project Number

yok

Minimal invasive percutaneous plate osteosynthesis (MIPPO) in humeral shaft fractures

Abstract

Purpose: We aimed to evaluate the radiological and functional results of humeral shaft fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) in our clinic.
Materials and Methods: Data of 21 humeral shaft fractures of 20 patients treated with MIPPO were evaluated retrospectively. Demographic data, type of injury, fracture classification according to AO classification and fracture location, smoking, radial nerve injury were recorded. Radiographically, the union at 6th month and alignment were evaluated. Objective results were evaluated in terms of shoulder and elbow range of motion. Subjective results were assessed by the American Shoulder and Elbow Society Score (ASES), University of California, Los Angles (UCLA) score, Mayo Elbow Performance Index (MEPI), the Disability of The Arm, Shoulder and Hand (DASH) Score and Constant Shoulder Score.
Results: The average elbow motion was 131.4° ± 19.8°. The mean ASES and UCLA scores were 88.5 ± 16.4 and 32.1 ± 5.2, respectively. The mean MEPI and DASH scores were 93.1 ± 11.3 and 11.8 ± 20.0, respectively, and the Constant score was mean 9.1 ± 15.3. Nonunion was observed in two patient at 6th month.
Conclusion: We believe that MIPPO is a successful technique for the treatment of humeral shaft fractures with minimal soft tissue damage, intact shoulder and elbow motion function.

Keywords

MIPPO, humeral fractures, minimal invasive surgical procedures, fracture fixation

Project Number

yok

References

• 1. Walker M, Palumbo B, Badman B, Brooks J, Gelderen JV, Mighell M, Humeral shaft fractures: a review. J Shoulder Elbow Surg 2011;20, 833-844
• 2. Igbigbi PS, Manda K, Epidemiology of humeral fractures in Malawi. Int Orthop 2004;28:338 41
• 3. Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. J Bone Joint Surg Br. 1998 Mar; 80(2):249-53.
• 4. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA.. J Bone Joint Surg Am 2000;82:478-86.
• 5. Toivanen JA, Nieminen J, Laine HJ, Honkonen SE, Järvinen MJ. Functional treatment of closed humeral shaft fractures. Int Orthop 2005; 29(1):10–13
• 6. Epps CH Jr, Grant RE, Fractures of the shaft of the humerus. In: Rockwood CA Jr, Green DP, Bucholz RW, editors. Rockwood and Green’s fractures in adults. 3rd ed. Philadelphia: Lippincott Williams& Williams; 1991.
• 7. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84:1093-110.
• 8. Brumback RJ, Bosse MJ, Poka A. Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma. J Bone Joint Surg Am 1986; 68:960-9.
• 9. Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma 2007;21:628-33.
• 10. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury 2005;36:530-8.
• 11. Bhandari M, Devereaux PJ, McKee MD, Schemitsch EH. Compression plating versus intramedullary nailing of humeral shaft fractures-a meta-analysis. Acta Orthop. 2006; 77:279–284.
• 12. Livani B, Belangero WD. Bridging plate osteosynthesis of humeral shaft fractures. Injury 2004; 35:587–595
• 13. Matsunaga FT, Tamaoki MJS, Matsumoto MH, Netto NA, Faloppa F, Belloti JC. Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures, J Bone Joint Surg Am. 2017;99:583-92.
• 14. Juan M. Concha, Alejandro Sandoval, Philipp N. Streubel. Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible? International Orthopaedics (SICOT) 2010; 34:1297–1305
• 15. Jawa A, McCarty P, Doornberg J, Harrıs M, Rıng D. Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg [Am] 2006;88(November (11)):2343–7
• 16. Singisetti K, Ambedkar M. Nailing versus plating in humerus shaft fractures: a prospective comparative study. Int Orthop. 2010 Apr;34 (4):571-6. Epub 2009 Jun 9.
• 17. 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):1469–1473.
• 18. Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft fractures in patients with multiple injuries. The Sunnybrook experience. J Bone Joint Surg Br 1985; 67:293–296.
• 19. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 2005; 87:1647–1652.
• 20. Jiang R, Luo CF, Zeng BF, Mei GH. Minimally invasive plating for complex humeral shaft fractures. Arch Orthop Trauma Surg. 2007;127(7):531–535
• 21. Benegas E, Neto AAF, Gracitelli MEC, Malavolta EA, Assuncao JH, Prada FDS . Shoulder function after surgical treatment of displaced fractures of the humeral shaft. J Shoulder Elbow Surg 2014; 23, 767-774.
• 22. Ziran BH, Belangero W, Livani B, Pesantez R. Percutaneous plating of the humerus with locked plating: technique and case report. J Trauma 2007; 63:205–210
• 23. Pospula W, Abu Noor T. Percutaneous Fixation of Comminuted Fractures of The Humerus: Initial Experience At Al Razi Hospital, Kuwait. Med Princ Pract 2006; 15:423-6.
• 24. Huri G, Biçer ÖS, Öztürk H, Devecı MA, Tan İ. Functional outcomes of minimal invasive percutaneous plate osteosynthesis (MIPPO) in humerus shaft fractures: a clinical study, Acta Orthop Traumatol Turc 2014; 48(4):406-412.
• 25. Numbela BX, Aceves LH, Gonzalez AB, Castro CT. Minimally invasive surgery in diaphyseal humeral fractures with helicoidal plate. One year result in seven patients. Acta Ortop Mex 2007; 21:239–246.
• 26. Klenerman L. Experimental fractures of the adult humerus. Med Biol Eng 1969; 7: 357- 364.
• 27. Fjalestad T, Strømsøe K, Salvesen P, Rostad B. Functional Results Of Braced Humeral Diaphyseal Fractures; Why Do 38% Lose External Rotation Of The Shoulder? Arch Orthop Trauma Surg 2000; 120 :281–285.
• 28. Oh CW, Byun YS, Oh JK, Kim JJ, Jeon IH, Lee JH, et al. Plating of humeral shaft fractures: Comparison of standard conventional plating versus minimally invasive plating. Orthopaedics & Traumatology: Surgery & Research 2012; 98, 54—60.
• 29. Kobayashi M, Watanabe Y, Matsushita T. Early full range of shoulder and elbow motion is possible after minimally invasive plate osteosynthesis for humeral shaft fractures. J Orthop Trauma. 2010;24(4):212–216.
• 30. Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma. 2000 Mar-Apr; 14(3):162-6.
• 31. Yuan H, et al. Comparison between intramedullary nailing and minimally invasive percutaneous plate osteosynthesis in treatment of humeral shaft fractures. J Coll Physicians Surg Pak. 2019;29(10):942–5.