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

Öz

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.

Anahtar Kelimeler

• Locking plate,humerus fracture,fracture fixation

Humerus Cisim Kırıklarının Kilitli Kompresyon Plakları ile Tedavi Etkinliğinin Değerlendirmesi

Öz

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.

Anahtar Kelimeler

• Kilitli plak,humerus kırığı,kırık tespiti

Kaynakça

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