Ulus Travma Acil Cerrahi Derg. 2023; 29(5): 627-632 | DOI: 10.14744/tjtes.2022.95482

Subgroups and differences of fixation in 3-part proximal humerus fractures

Taner Bekmezci¹, Serdar Kamil Çepni^2
1Private Practice Orthopaedics and Traumatology, Ýstanbul-Türkiye
²Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Ýstanbul-Türkiye

BACKGROUND: This study aimed to determine the morphological differences of three-part proximal humerus fractures, the group in which plate screw fixation is most frequently used, and to evaluate the functional and radiological results of the methods applied for different subgroups.
METHODS: Twenty-nine patients (6 males and 23 females) with three-part proximal humerus fractures were in the study, with an average age of 64. The patients were in three groups according to their fracture types. Group 1 included eight patients with valgus impaction fracture. Group 2 included eleven patients with easily achieved stability after reduction. Group 3 consisted of ten patients with procurvatum varus angulation, a significant displacement between fragments, and in whom medial cortical continuity was not maintained without fixation. All patients underwent surgery with a minimally invasive deltoid split approach method and locked ana-tomic plate screw osteosynthesis. In group 1 patients, the space in the area where valgization is present in the head was filled with cortico-cancellous allografts. No grafting or metaphyseal compression took place in Group 2 patients. In group 3 patients, the metaphyseal compression technique was applied to the bone defect area. Cephalodiaphyseal angles (CDA) were measured at the postoperative and final follow-up. The constant Murley score made the functional evaluation.
RESULTS: The patients were followed for an average of 27.6 months, and the union was present in all patients for an average of 3.6 months. Early screw migration was present in three patients, and late screw migration was in one patient. There were twenty-four excellent and 5 good results. CDA decreased from 139.42° to 136.13°. A statistically significant difference was present between the values of Groups 2 and 3 in the final control CDA of the groups.
CONCLUSION: In this study, the functional scores of grafting stable valgus-impacted fractures and metaphyseal compression of unstable fractures with insufficient medial support were as good as stable 3-part fractures. Considering neer type 3 fractures should be evaluated with their subgroups, and fixation and stability-enhancing solutions specific to the groups are essential.

Keywords: Locking plate, minimally invasive plate-screw osteosynthesis, neer type 3; proximal humerus fracture; valgus impacted fracture.

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Üç parçalý proksimal humerus kýrýklarýnda altgruplar ve tespit farklýlýklarý

Taner Bekmezci¹, Serdar Kamil Çepni^2
1Özel Muayenehane, Ortopedi ve Travmatoloji, Ýstanbul
²Ümraniye Eðitim ve Araþtýrma Hastanesi Ortopedi ve Travmatoloji Kliniði, Ýstanbul

AMAÇ: Bu çalýþmada, plak vida ile tespitin en sýk kullanýldýðý grup olan üç parçalý proksimal humerus kýrýklarýnýn morfolojik farklýlýklarýnýn belirlenmesi ve farklý vakalarda uygulanan yöntemlerin fonksiyonel ve radyolojik sonuçlarýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Üç parçalý proksimal humerus kýrýðý olan 29 hasta (6 erkek-23 kadýn) deðerlendirildi. Ortalama yaþ 64 idi. Hastalar kýrýk tiplerine göre 3 gruba ayrýldý. Grup 1, valgus impaksiyon kýrýðý olan sekiz hastayý içeriyordu. Grup 2, redüksiyon sonrasý kolayca stabilite saðlanan 11 hastayý içeriyordu. Grup 3, prokurvatum varus açýlanmasý, fragmanlar arasýnda önemli yer deðiþtirmesi olan ve fiksasyon olmadan medial kortikal devamlýlýðýn saðlanamadýðý on hastadan oluþuyordu. Tüm hastalar minimal invaziv deltoid split yaklaþým yöntemi ve kilitli anatomik plak vida oste-osentezi ile ameliyat edildi. Grup 1 hastalarda baþýn valg olduðu alan kortiko-kansellöz allogreft ile dolduruldu. Grup 2 hastalarýna greftleme veya metafizer basý uygulanmadý. Grup 3 hastalarda kemik defekti bölgesine metafizyal kompresyon tekniði uygulandý. Ameliyat sonrasý ve son takipte sefalodiyafiz açýlarý ölçüldü. Fonksiyonel deðerlendirme için Constant Murley skoru kullanýldý.
BULGULAR: Hastalar ortalama 27.6 ay takip edildi ve ortalama 3.6 ayda tüm hastalarda kaynama görüldü. Üç hastada erken vida migrasyonu, bir hastada geç vida migrasyonu izlendi. 24 mükemmel ve 5 iyi sonuç gözlendi. Sefalodiyafiz açýlarý 139.42 dereceden 136.13 dereceye düþtü. Son kont-rol sefalodiyafiz açýlarýnýn gruplara daðýlýmýnda grup 2 ve grup 3 deðerleri arasýnda istatistiksel olarak anlamlý fark gözlendi.
TARTIÞMA: Bu çalýþmada, greftleme stabil valgus impakte kýrýklarýn fonksiyonel skorlarýnýn ve medial desteði yetersiz olan stabil olmayan kýrýklarýn metafizyal kompresyonunun stabil 3 parçalý kýrýklar kadar iyi olduðunu bulduk. Neer tip 3 kýrýklar alt gruplarý ile birlikte deðerlendirilmeli, gruplara özel tespit ve stabilite artýrýcý çözümler düþünülmelidir.

Anahtar Kelimeler: Kilitli plak, proksimal humerus kýrýðý, MIPO; Neer tip 3; valgus impakte kýrýk.

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