Trikha Vivek, Singh Vivek, Choudhury Buddhadeb, Das Saubhik
Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
J Shoulder Elbow Surg. 2017 Oct;26(10):e293-e299. doi: 10.1016/j.jse.2017.03.035. Epub 2017 May 15.
Fracture-dislocation is the extreme variant of injury to the proximal humerus that occurs more commonly in young adults as a result of high-velocity trauma. We evaluated the functional and radiologic outcome of fixation of proximal humeral fracture-dislocations with locked plates.
This was a retrospective review of 33 proximal humeral fracture-dislocations in 29 patients with a mean age of 35 years (range, 19-60 years) treated by open reduction and internal fixation with locked plates between January 2009 and December 2013. The fracture-dislocation in 85% was the result of high-energy trauma resulting in 3- or 4-part fracture-dislocation. The fracture-dislocation was anterior in 27 and posterior in 6.
The average delay from injury to surgery was 7 days (range, 1-35 days), with a mean follow-up of 40 months (range, 24-66 months). All of the fractures united at an average of 15 weeks after surgery. At the final follow-up, the mean forward flexion was 129° (range, 100°-160°), and mean abduction was 128° (range, 100°-150°). The mean Constant score at the final follow-up was 78 points (range, 68-88 points). One case of complete osteonecrosis of the humeral head and 1 case of partial osteonecrosis of the humeral head were noted. Two cases of screw perforation of the humeral head were seen, with subsequent restricted range of motion improving after removal of the offending screws.
Most young patients with 3- and 4-part proximal humeral fracture-dislocations can achieve good functional outcome after fixation with locked plates.
骨折脱位是肱骨近端损伤的极端类型，多因高速创伤发生于年轻成年人。我们评估了使用锁定钢板固定肱骨近端骨折脱位的功能和影像学结果。
这是一项对29例患者的33例肱骨近端骨折脱位的回顾性研究，患者平均年龄35岁（范围19 - 60岁），于2009年1月至2013年12月接受切开复位并用锁定钢板内固定治疗。85%的骨折脱位是高能创伤所致，导致三部分或四部分骨折脱位。骨折脱位位于前方的有27例，位于后方的有6例。
从受伤到手术的平均延迟时间为7天（范围1 - 35天），平均随访40个月（范围24 - 66个月）。所有骨折均在术后平均15周愈合。在末次随访时，平均前屈为129°（范围100° - 160°），平均外展为128°（范围100° - 150°）。末次随访时平均Constant评分为78分（范围68 - 88分）。发现1例肱骨头完全坏死和1例肱骨头部分坏死。观察到2例螺钉穿出肱骨头，取出相关螺钉后，随后受限的活动范围有所改善。
大多数年轻的肱骨近端三部分和四部分骨折脱位患者使用锁定钢板固定后可获得良好的功能结果。
