Est-il justifi茅 d鈥檕steosynth猫ser les fractures de l鈥檋umerus proximal au prix d鈥檜n risque accru d鈥檕st茅on茅crose?

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• 作者：H. Thomazeau^a ; ^{herve.thomazeau@chu-rennes.fr} ; J. Richou^b ; T. Benkalfalte^c ; G. Kerhousse^a ; D. Le Nen^b ; D. Veillard^a
• 关键词：Humeral fracture ; Nailing ; Osteonecrosis ; Malunion
• 刊名：Revue de Chirurgie Orthop篓娄dique et Traumatologique
• 出版年：2012
• 期刊代码：pca328_18770517
• 类别：med
• 出版时间：June, 2012
• 卷：98
• 期：4
• 页码：342-343
• 文件大小：194 K

摘要

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Summary

Objective

To evaluate fixation of proximal humeral fractures by anterograde nailing, in terms of 1) fracture reduction, bone healing 2) osteonecrosis 3) functional consequences of osteonecrosis and malunion.

Design

Prospective, consecutive, multicenter based.

Setting

Academic Trauma Centers; Approval was received from the ethics committee of the institutions involved in the study.

Methods

Fifty-one patients were enrolled prospectively, with 31聽three-part and 20聽four-part displaced fractures (head displacement > 45掳, tuberosity-head gap > 10 mm, diaphyseal gap  > 10 mm). A Telegraph鈩?nail (FH Orthopedics, Heimsbrunn, France) was the fixation device used, introduced through a superolateral transdeltoid approach under fluoroscopic guidance. The assessment included Simple Shoulder Test, absolute Constant score, X-rays every 3聽months and CT-scan at final evaluation. Twelve patients died and one was lost to follow-up. Immediate complications included secondary displacement in four patients.

Results

There were no infections, no deltoid muscle or axillary nerve damage, and all the fractures united. After a mean follow-up of 24.1聽months, malunion was observed in 29聽%of the remaining 38聽patients and osteonecrosis in 32聽%. Both complications were more frequent and extensive in patients with four-part fractures. The osteonecrosis area influenced the Constant score, which was 55.8聽points when the area was < 30聽%, 50.6聽points between 30聽and 50聽%, and 38聽points when larger than 50聽%. Head malunion affected the Simple Shoulder Test and the Constant score.

Conclusion

Nailing may thus be recommended for three-part fractures, because osteonecrosis is less frequent, more focused, and better tolerated in this sub-group. In contrast, antegrade nailing was not more beneficial than other internal fixation techniques for preventing osteonecrosis or head malunion in patients with four-part fractures.

Level IV

Prospective study.