Orthopaedic and Traumatology Department, University Hospital of Toulouse, Toulouse, France,
Int Orthop. 2013 Oct;37(10):1965-71. doi: 10.1007/s00264-013-1926-1. Epub 2013 May 21.
The Kapandji pinning was initially described for the treatment of surgical neck fractures of the humerus in young patients. The aim of our study was to evaluate functional and radiological outcomes of the Kapandji modified technique in displaced complex three- and four-part fractures.
From 2005 to 2009, 32 patients (23 three-part and nine four-part fractures) were included retrospectively. The mean age was 63 years old (range, 22-86), and the dominant shoulder was involved in 40% of the cases.
At a mean follow up of 25 months (12-72), the mean absolute Constant score achieved 68 points (35-98) and adjusted score 80% (47-100). Patients had an average forward elevation of the shoulder of 132° (80°-180°), an average external rotation of 36° (0°-90°), and an average internal rotation to the level of L1 (sacrum to the level of T6). The older the patients were the worst was the active anterior elevation recovery (r = -0.3; p = 0.01). Reduction and fixation of initial varus-displaced fractures was not as reliable as in valgus. In eight cases (25%), K-wire migrations were observed and were correlated with age over 70 years old (p = 0.001). Two partial osteolysis of the greater tuberosity and two avascular necrosis of the humeral head (one was associated with a non-union) were identified. Moreover, three patients developed adhesive capsulitis.
The Kapandji technique with fixation of tuberosities provides satisfactory results for the treatment of complex proximal fractures of the humerus. However, we do not recommend this technique for patients older than 70 years and in cases of varus displaced fractures.
Kapandji 钉固定术最初用于治疗年轻患者的肱骨外科颈骨折。我们的研究目的是评估 Kapandji 改良技术治疗移位复杂三部分和四部分骨折的功能和影像学结果。
回顾性纳入 2005 年至 2009 年的 32 名患者（23 例三部分骨折和 9 例四部分骨折）。平均年龄为 63 岁（范围 22-86 岁），40%的病例为优势肩。
平均随访 25 个月（12-72 个月），平均绝对 Constant 评分达到 68 分（35-98 分），调整后评分 80%（47-100 分）。患者的肩部平均前屈为 132°（80°-180°），外展平均为 36°（0°-90°），内旋平均可达 L1 水平（骶骨至 T6 水平）。患者年龄越大，主动前屈恢复越差（r = -0.3；p = 0.01）。初始内翻移位骨折的复位和固定不如外翻可靠。在 8 例（25%）中观察到 K 线迁移，且与 70 岁以上的年龄相关（p = 0.001）。发现 2 例大结节部分骨溶解和 2 例肱骨头缺血性坏死（1 例与骨不连相关），此外，3 例患者发生粘连性肩关节囊炎。
Kapandji 技术固定结节可获得满意的治疗效果复杂的肱骨近端骨折。然而，我们不建议 70 岁以上的患者和内翻移位骨折的患者使用这种技术。
