Joint-preserving treatment for type 3 sequelae following fracture of the proximal humerus with small head fragments.
Aged
Aged, 80 and over
Bone Wires
Female
Fracture Fixation, Internal
/ instrumentation
Fracture Healing
Fractures, Ununited
/ etiology
Humans
Male
Middle Aged
Patient Satisfaction
Range of Motion, Articular
Reoperation
Retrospective Studies
Shoulder Fractures
/ diagnostic imaging
Shoulder Joint
Treatment Outcome
Journal
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
ISSN: 1436-2023
Titre abrégé: J Orthop Sci
Pays: Japan
ID NLM: 9604934
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
13
06
2018
revised:
12
11
2018
accepted:
29
11
2018
pubmed:
26
12
2018
medline:
25
1
2020
entrez:
25
12
2018
Statut:
ppublish
Résumé
Although nonunions of the proximal humerus are rare, they cause significant disability to patients. Surgical reconstruction is challenging, especially with small and excavated head fragments. A promising surgical option is open reduction and stabilization using the Humerusblock device along with tension wires. The aim of this retrospective investigation was to evaluate the clinical and radiological results of this procedure. Fifteen patients with symptomatic surgical neck nonunions were treated with open reduction and internal fixation using the Humerusblock device without bone grafting. All patients showed a loss of bone stock, leading to excavated head fragments. The mean interval from injury to the described treatment was 6.2 months (range, 3.4-10.7). At a mean follow-up of 40.5 months, the Constant-Murley score was documented, pain and patient satisfaction were evaluated using a visual analogue scale, and x-rays were taken in two planes. The patients' mean age was 69.7 years (range, 52-83). The mean Constant-Murley score improved from 24 points before surgery to 62 points at follow-up, which was an average of 80.8% of the score obtained for the contralateral arm. Radiological examination confirmed bony healing in 14 patients. All but one patient felt satisfied with the results. Three patients required revision surgery because of a hematoma, and early metal removal was performed in one patient because of infection. Nonunions of humeral surgical neck fractures can be successfully treated by fixation using the Humerusblock device along with tension wires without the need for additional bone grafting. Especially in patients with flat, concave head fragments, this procedure remains a promising reconstructive option to arthroplasty. Level IV; Therapeutic retrospective case series.
Sections du résumé
BACKGROUND
BACKGROUND
Although nonunions of the proximal humerus are rare, they cause significant disability to patients. Surgical reconstruction is challenging, especially with small and excavated head fragments. A promising surgical option is open reduction and stabilization using the Humerusblock device along with tension wires. The aim of this retrospective investigation was to evaluate the clinical and radiological results of this procedure.
MATERIALS AND METHODS
METHODS
Fifteen patients with symptomatic surgical neck nonunions were treated with open reduction and internal fixation using the Humerusblock device without bone grafting. All patients showed a loss of bone stock, leading to excavated head fragments. The mean interval from injury to the described treatment was 6.2 months (range, 3.4-10.7). At a mean follow-up of 40.5 months, the Constant-Murley score was documented, pain and patient satisfaction were evaluated using a visual analogue scale, and x-rays were taken in two planes.
RESULTS
RESULTS
The patients' mean age was 69.7 years (range, 52-83). The mean Constant-Murley score improved from 24 points before surgery to 62 points at follow-up, which was an average of 80.8% of the score obtained for the contralateral arm. Radiological examination confirmed bony healing in 14 patients. All but one patient felt satisfied with the results. Three patients required revision surgery because of a hematoma, and early metal removal was performed in one patient because of infection.
CONCLUSION
CONCLUSIONS
Nonunions of humeral surgical neck fractures can be successfully treated by fixation using the Humerusblock device along with tension wires without the need for additional bone grafting. Especially in patients with flat, concave head fragments, this procedure remains a promising reconstructive option to arthroplasty.
LEVEL OF EVIDENCE
METHODS
Level IV; Therapeutic retrospective case series.
Identifiants
pubmed: 30580889
pii: S0949-2658(18)30368-3
doi: 10.1016/j.jos.2018.11.020
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
618-623Informations de copyright
Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.