Ulus Travma Acil Cerrahi Derg. 2022; 28(6): 824-831 | DOI: 10.14744/tjtes.2021.99078

Does plate-screw density affect the functional outcomes in the treatment of proximal humerus fractures?

Alkan Bayrak¹, Altuð Duramaz¹, Alican Koluman¹, Cemal Kural¹, Nezih Ziroðlu², Kadir Gözügül³, Gökhan Peker^4
1Department of Orthopedics and Traumatology, University of Health Sciences Bakýrköy Dr. Sadi Konuk Training and Research Hospital, Ýstanbul-Turkey
²Department of Orthopedics and Traumatology, Beylikdüzü State Hospital, Ýstanbul-Turkey
³Department of Orthopedics and Traumatology, Iðdýr State Hospital, Orthopedics and Traumatology, Iðdýr-Turkey
⁴Department of Orthopedics and Traumatology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon-Turkey

BACKGROUND: The aim of the study is to evaluate the relationship between plate-screw density (PSD), functional results, and complication rates in the treatment of proximal humerus fractures (PHFs) with proximal humerus locking anatomical plate (PHLAP).
METHODS: Consecutive 43 patients (22 females and 21 males) who underwent PHLAP for the treatment of PHF between 2010 and 2016 were evaluated. AO classifications were used for the classification of fractures. Based on the biomechanical stability the-ory of Erhardt et al., the patients were divided into two groups as <60% and >60% according to the number of screws fixed to the humeral head for the determination of PSD. The patients were divided into two groups as PSD <60% (n=21) and PSD>60% (n=22) according to the number of screws fixed to the humeral head for the determination of PSD. Functional results were evaluated using the Constant-Murley shoulder score (CMS). Radiological evaluation was performed with collodiaphyseal angle (CDA), varus-valgus angulation, avascular necrosis (AVN), and arthrosis. The groups were compared in terms of demographic characteristics, functional results, radiological scores, and complications.
RESULTS: The mean age was 54.47±17.43 years and the mean follow-up time was 19.51±5.27 months. Although the CMS scores of patients with a PSD of over 60% were higher than those below 60%, the CMS score did not differ statistically. In groups, the mean CDA of the operated shoulder was significantly lower than that of the non-injured side (p=0.002). Eight patients had varus angulation, whereas two patients had humerus head AVN. No significant relationship was observed between PDS and functional scores, radiolog-ical results, and complications.
CONCLUSION: Functional results of PSD >60% are higher than PSD <60% group but there is no statistical difference between groups according to functional, radiological results, and complications.

Keywords: Functional score, plate-screw density, proximal humeral fractures; proximal humerus locking anatomical plate.

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Proksimal humerus kýrýklarýnýn tedavisinde plak-vida yoðunluðu fonksiyonel sonuçlarý etkiler mi?

Alkan Bayrak¹, Altuð Duramaz¹, Alican Koluman¹, Cemal Kural¹, Nezih Ziroðlu², Kadir Gözügül³, Gökhan Peker^4
1Saðlýk Bilimleri Üniversitesi, Bakýrköy Dr. Sadi Konuk Eðitim ve Araþtýrma Hastanesi, Ortopedi ve Travmatoloji Kliniði, Ýstanbul
²Beylikdüzü Devlet Hastanesi, Ortopedi ve Travmatoloji Kliniði, Ýstanbul
³Iðdýr Devlet Hastanesi, Ortopedi ve Travmatoloji, Iðdýr
⁴Saðlýk Bilimleri Üniversitesi, Trabzon Kanuni Eðitim ve Araþtýrma Hastanesi, Ortopedi ve Travmatoloji Kliniði, Trabzon

AMAÇ: Çalýþmanýn amacý, proksimal humerus kýrýklarýnýn (PHK) proksimal humerus kilitli anatomik plak (PHKAP) ile tedavisinde plak-vida yoðun-luðu (PVY), fonksiyonel sonuçlar ve komplikasyon oranlarý arasýndaki iliþkiyi deðerlendirmektir.
GEREÇ VE YÖNTEM: Þubat 2010–Aralýk 2016 tarihleri arasýnda PHK tedavisi için PHKAP uygulanan ardýþýk 43 hasta (K: 22, E: 21) deðerlendirildi. Kýrýklarýn sýnýflandýrýlmasýnda AO sýnýflandýrmasý kullanýldý. Hastalar humerus baþýna uygulanan vida sayýsýna göre PVY <%60 ve PVY >%60 olarak iki gruba ayrýldý. Fonksiyonel sonuçlar Constant-Murley omuz skoru (CMS) kullanýlarak deðerlendirildi. Radyolojik deðerlendirme kollodiafizer açý (KDA), varus-valgus açýlanmasý, avasküler nekroz ve artroz ile yapýldý. Gruplar demografik özellikler, fonksiyonel sonuçlar, radyolojik skorlar ve komplikasyonlar açýsýndan karþýlaþtýrýldý.
BULGULAR: Plak-vida yoðunluðu %60’ýn üzerinde olan hastalarýn CMS skorlarý PVY’u %60’ýn altýndakilerden daha yüksek olmasýna raðmen, CMS skorlarý arasýnda istatistiksel olarak farklýlýk görülmemiþtir. Gruplarda, ameliyat edilen omzun ortalama KDA’sý yaralanmamýþ tarafa göre anlamlý ola-rak daha düþüktü (p=0.002). Sekiz hastada varus açýlanmasý, iki hastada humerus baþý avasküler nekrozu vardý. PVY ile fonksiyonel skorlar, radyolojik sonuçlar ve komplikasyonlar arasýnda anlamlý bir iliþki gözlenmedi.
TARTIÞMA: Proksimal humerus kýrýklarýnýn cerrahi tedavisinde PVY, PHKAP uygulamasýndaki fonksiyonel, radyolojik sonuçlarý ve komplikasyonlarý anlamlý olarak etkilememektedir.

Anahtar Kelimeler: Fonksiyonel skor, plak-vida yoðunluðu, proksimal humerus kýrýklarý, proksimal humerus kilitli anatomik plak.

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