Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures

SEEBACH, Caroline; GEIGER, Emanuel V.; KELM, Arme; MAIER, Marcus; WUTZLER, Sebastian; MARZI, Ingo

Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures

Emanuel V. GEIGER, (Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany)

Marcus MAIER, (Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany)

Arme KELM, (Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany)

Sebastian WUTZLER, (Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany)

Caroline SEEBACH, (Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany)

Ingo MARZI (Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany)

Acta Orthopaedica et Traumatologica Turcica

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Yıl: 2010 Cilt: 44 Sayı: 1 Sayfa Aralığı: 1 - 6 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures

Öz:

Amaç: Tüm kırıkların yaklaşık %5’ini proksimal humerus kırıkları oluşturur. Stabiliteyi artırmak için yeni plak teknikleri geliştirilmiştir. Bu çalışmada, proksimal humerus kırıklarında Proksimal Humerus İnternal Kilit Sistemi (Proximal Humeral Internal Locking System-PHILOS) plağı ile tespitin fonksiyonel sonuçları değerlendirildi ve implantla ilişkili potansiyel komplikasyonlar incelendi. Çalışma planı: Ayrışmış proksimal humerus kırığı olan 28 hastaya (20 kadın, 8 erkek; ort. yaş 60.7±12.9) PHILOS plağı ile internal tespit uygulandı. Kırık nedeni 21 hastada düşük enerjili travma (boy hizasından düşme), yedi hastada kayak ya da bisiklet kazasıydı. Kırık 16 hastada sağ, 12 hastada sol taraftaydı. Neer sınıflamasına göre, sekiz hastada iki parça, 12 hastada üç parça, sekiz hastada dört parça ayrışmış kırık vardı. Tüm hastalara PHILOS plağı ile internal tespitin ardından benzer fizik tedavi programı uygulandı. Hastalar klinik ve radyografik olarak ortalama 25.2±11.8 aylık takip sonunda değerlendirildi. Fonksiyonel sonuçlar için yaş ve cinsiyete göre ayarlanmış Constant-Murley skoru kullanıldı. Hareket açıklığı ve omuz abdüksiyon kuvveti ölçüldü. Hastalar ayrıca Kol, Omuz ve El Sorunları Anketi (Disabilities of the Arm, Shoulder, and Hand-DASH) ve görsel analog skala ile değerlendirildi. Takip sırasında görülen komplikasyonlar kaydedildi. Sonuçlar: Yirmi kırık (%71.4) iyi anatomik konumda iyileşti. Takip süresi sonunda ortalama Constant-Murley skoru 57.9±21.7, yaş ve cinsiyete göre ayarlanmış Constant-Murley skoru ise 67.5±23.6 bulundu. On altı hastada (%57.1) mükemmel veya iyi, bir hastada (%3.6) orta, 11 hastada (%39.3) kötü sonuç elde edildi. Ortalama DASH ve görsel analog skala skorları sırasıyla 28.3±24.3 ve 75.4±21.2 bulundu. Takip sırasında 11 komplikasyon (%39.3) görüldü. Sekiz hastada (%72.3) yeniden ameliyat gerekti. Komplikasyonlar iki hastada (%7.2) humerus başı avasküler nekrozu, altı hastada (%21.4) subakromiyal sıkışma, bir hastada (%3.6) kilit vidasında gevşeme ve iki hastada (%7.2) radial sinirde geçici duyu kaybı şeklinde idi. Subakromiyal sıkışma esas olarak plağın süperior konumundan kaynaklanıyordu. Çıkarımlar: Sonuçlarımız, yaşlı hastalardaki proksimal humerus kırıklarında PHILOS plağı ile yeterli kırık stabilizasyonu sağlanabileceğini göstermektedir.

Anahtar Kelime: Kırık tespiti, internal Kemik plakları Tedavi sonucu Omuz kırıkları Düşme kazaları İzleme çalışmaları Yara iyileşmesi Ameliyat sonrası komplikasyonlar Reoperasyon Donanım tasarımı

Konular: Cerrahi

Proksimal humerus kırıklarında PHILOS plağı ile tespitin fonksiyonel sonuçları ve komplikasyonları

Öz:

Objectives: Proximal humeral fractures account for approximately 5% of all fractures. New plating techniques have been developed to improve stability. The purpose of this study was to evaluate functional outcome following plate fixation with the Proximal Humeral Internal Locking System (PHILOS) and to analyze potential implant-related complications. Methods: The PHILOS plate was used for internal fixation of displaced proximal humeral fractures in 28 patients (20 females, 8 males; mean age 60.7±12.9 years). Fractures were caused by low-energy trauma (fall from standing height) in 21 patients, and by an accident while skiing or cycling in seven patients. Involvement was on the right in 16 cases and on the left in 12 cases. According to the Neer classification, 8, 12, and 8 patients had displaced 2-, 3-, or 4-part fractures, respectively. All patients received a similar physical therapy program following internal fixation with the PHILOS plate. The patients were assessed clinically and radiographically after a mean follow-up of 25.2±11.8 months. Functional outcome was assessed using the Constant- Murley score adjusted for age and gender. Range of motion and shoulder abduction strength were measured. The patients were also evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a visual analog scale (VAS). Complications during the follow-up period were recorded. Results: Twenty fractures (71.4%) healed in good anatomical position. At the end of the followup period, the mean Constant-Murley score was 57.9±21.7, and the mean age- and gender-adjusted Constant-Murley score was 67.5±23.6. The results were excellent or good in 16 patients (57.1%), moderate in one patient (3.6%), and poor in 11 patients (39.3%). The mean DASH and VAS scores were 28.3±24.3 and 75.4±21.2, respectively. Eleven complications (39.3%) were seen during the follow-up period. Reoperation was required in eight patients (72.3%). Complications included avascular necrosis of the humeral head in two patients (7.2%), subacromial impingement in six patients (21.4%), loosening of a locking head screw in one patient (3.6%), and transiently decreased radial nerve sensation in two patients (7.2%). Subacromial impingement was mainly caused by the superior plate position. Conclusion: Our results demonstrate that the PHILOS plate provides sufficient fracture stabilization in the treatment of proximal humeral fractures of elderly patients.

Anahtar Kelime: Accidental Falls Follow-Up Studies Wound Healing Postoperative Complications Reoperation Equipment Design Fracture Fixation, Internal Bone Plates Treatment Outcome Shoulder Fractures

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Bibliyografik

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APA	GEIGER E, MAIER M, KELM A, WUTZLER S, SEEBACH C, MARZI I (2010). Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. , 1 - 6.
Chicago	GEIGER Emanuel V.,MAIER Marcus,KELM Arme,WUTZLER Sebastian,SEEBACH Caroline,MARZI Ingo Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. (2010): 1 - 6.
MLA	GEIGER Emanuel V.,MAIER Marcus,KELM Arme,WUTZLER Sebastian,SEEBACH Caroline,MARZI Ingo Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. , 2010, ss.1 - 6.
AMA	GEIGER E,MAIER M,KELM A,WUTZLER S,SEEBACH C,MARZI I Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. . 2010; 1 - 6.
Vancouver	GEIGER E,MAIER M,KELM A,WUTZLER S,SEEBACH C,MARZI I Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. . 2010; 1 - 6.
IEEE	GEIGER E,MAIER M,KELM A,WUTZLER S,SEEBACH C,MARZI I "Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures." , ss.1 - 6, 2010.
ISNAD	GEIGER, Emanuel V. vd. "Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures". (2010), 1-6.

APA	GEIGER E, MAIER M, KELM A, WUTZLER S, SEEBACH C, MARZI I (2010). Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthopaedica et Traumatologica Turcica, 44(1), 1 - 6.
Chicago	GEIGER Emanuel V.,MAIER Marcus,KELM Arme,WUTZLER Sebastian,SEEBACH Caroline,MARZI Ingo Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthopaedica et Traumatologica Turcica 44, no.1 (2010): 1 - 6.
MLA	GEIGER Emanuel V.,MAIER Marcus,KELM Arme,WUTZLER Sebastian,SEEBACH Caroline,MARZI Ingo Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthopaedica et Traumatologica Turcica, vol.44, no.1, 2010, ss.1 - 6.
AMA	GEIGER E,MAIER M,KELM A,WUTZLER S,SEEBACH C,MARZI I Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthopaedica et Traumatologica Turcica. 2010; 44(1): 1 - 6.
Vancouver	GEIGER E,MAIER M,KELM A,WUTZLER S,SEEBACH C,MARZI I Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthopaedica et Traumatologica Turcica. 2010; 44(1): 1 - 6.
IEEE	GEIGER E,MAIER M,KELM A,WUTZLER S,SEEBACH C,MARZI I "Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures." Acta Orthopaedica et Traumatologica Turcica, 44, ss.1 - 6, 2010.
ISNAD	GEIGER, Emanuel V. vd. "Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures". Acta Orthopaedica et Traumatologica Turcica 44/1 (2010), 1-6.