Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Department of Trauma Surgery, Wilhelminenspital Wien, Montleartstraße 37, 1160, Vienna, Austria.
Arch Orthop Trauma Surg. 2020 Oct;140(10):1413-1421. doi: 10.1007/s00402-020-03362-1. Epub 2020 Mar 4.
Screw-tip augmentation in angular stable plating offers new possibilities for the treatment of complex proximal humerus fractures. This retrospective analysis was performed to evaluate the radiological outcome of proximal humerus fractures treated with angular stable plates and additional screw-tip cement augmentation in patients over the age of 60.
A retrospective single centre analysis was conducted from June 2013 to December 2016. The minimum follow-up time was set to 6 months after surgery. Anatomical reduction and fixation were evaluated in respect to reattached tuberosities to the head fragment and the adequate restoration of the calcar area not showing any valgus or varus malalignment. Complete fracture healing was determined 3 months after surgery. Any failures such as secondary displacement, primary screw perforation, intraarticular cement leakage and avascular necrosis of the humeral head with concomitant screw cut-out were assessed.
In total, 24 patients (21 females; 3 males) at a median age of 77.5 (62-96) years were included. Five 2-part, twelve 3-part and seven 4-part fractures were detected. The measured median BMD value of 23 patients was 78.4 mg/cm (38.8-136.9 mg/cm). Anatomical reduction was achieved in 50% of the patients. In most cases, the A level screws and the B1 screw were augmented with bone cement by a median of 7 (5-9) head screws used. Postoperative varus displacement was not detected in any of the patients. One patient (4.2%) sustained an early secondary displacement. Intraarticular cement leakage was detected in 3 patients (2 head-split fractures). Avascular necrosis of the humeral head was observed in 4 patients (16.7%). Revision surgery was necessary in four cases, using hemiarthroplasty twice and reverse shoulder arthroplasty the other two times.
Screw-tip augmentation in angular stable plating for proximal humerus fracture treatment showed a low secondary displacement rate of 4.2% in patients suffering from poor bone quality. Nevertheless, the occurrence of avascular necrosis of the humeral head with mainly severe fracture patterns observed in this study was higher compared to previously reported results in the literature. Cement augmentation in head-split fractures is not recommended, considering the high risk of an intraarticular cement leakage.
在角稳定钢板中使用钉尖增强为治疗复杂肱骨近端骨折提供了新的可能性。本回顾性分析旨在评估 60 岁以上患者使用角稳定钢板和附加钉尖水泥增强治疗肱骨近端骨折的放射学结果。
2013 年 6 月至 2016 年 12 月进行了回顾性单中心分析。术后随访时间至少为 6 个月。评估再附着结节与头节段的解剖复位和固定情况，以及适当恢复无内翻或外翻对线不良的 calcar 区域。术后 3 个月确定完全骨折愈合。评估任何失败情况，如继发性移位、初次螺钉穿透、关节内水泥渗漏和伴有螺钉穿出的肱骨头缺血性坏死。
共纳入 24 例患者（21 名女性；3 名男性），平均年龄 77.5（62-96）岁。5 例为 2 部分骨折，12 例为 3 部分骨折，7 例为 4 部分骨折。23 例患者的中位 BMD 值为 78.4mg/cm（38.8-136.9mg/cm）。50%的患者达到解剖复位。在大多数情况下，使用中位 7（5-9）枚头钉对 A 级螺钉和 B1 螺钉进行骨水泥增强。术后未发现任何患者出现内翻移位。1 例（4.2%）患者发生早期继发性移位。3 例（2 例为头劈裂骨折）患者出现关节内水泥渗漏。4 例（16.7%）患者发生肱骨头缺血性坏死。4 例患者需要进行翻修手术，其中 2 例采用半髋关节置换术，2 例采用反肩关节置换术。
在治疗肱骨近端骨折时，角稳定钢板的钉尖增强在骨质量较差的患者中显示出较低的继发性移位率（4.2%）。然而，与文献中先前报道的结果相比，本研究中观察到的主要为严重骨折类型的肱骨头缺血性坏死发生率更高。考虑到头劈裂骨折中关节内水泥渗漏的高风险，不建议进行水泥增强。
