Lorenz Greta, Schönthaler Wolfgang, Huf Wolfgang, Komjati Micha, Fialka Christian, Boesmueller Sandra
Department of Trauma Surgery, AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria.
Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Eur J Trauma Emerg Surg. 2021 Dec;47(6):2055-2064. doi: 10.1007/s00068-020-01380-7. Epub 2020 May 24.
There is still disagreement regarding the optimal surgical treatment of three- and four-part fractures of the proximal humerus. The aim of this monocentric, retrospective study was to compare the complication rate of internal fixation with a locking plate versus proximal humeral nailing after a one-year follow-up.
From 2005 to 2016, 292 patients suffered a fracture of the proximal humerus and were treated surgically at our level-I trauma center. According to the inclusion criteria, 50 patients were included in this study: 19 of these (11 three-part fractures and 8 four-part fractures) were treated with a proximal humeral nail (HN) and 31 (12 three-part fractures and 19 four-part fractures) with a locking plate (LP) osteosynthesis. Classification was performed according to the Hertel classification. At a 1-year follow-up, the complication rate of the two treatment methods was compared.
Twenty patients (40%) suffered at least one complication. Of these, six patients (12%) were treated with a HN and 14 (28%) with a LP (p = 0.39). The most frequent complication was screw perforation (22%), followed by non-union (16%). Humeral head necrosis (10%) occurred only in the LP cohort. One wound infection occurred in a patient treated with a HN. Four-part fractures were treated more frequently with a LP. However, the difference was non-significant in this sample (p = 0.186).
The results of our study provide some evidence that in terms of complication rate, both treatment options are comparable for internal fixation of three- and four-part fractures of the proximal humerus. The type of fracture seems to be decisive for the choice of implant.
对于肱骨近端三部分和四部分骨折的最佳手术治疗方法仍存在分歧。本单中心回顾性研究的目的是比较锁定钢板内固定与肱骨近端髓内钉在一年随访后的并发症发生率。
2005年至2016年期间，292例肱骨近端骨折患者在我们的一级创伤中心接受了手术治疗。根据纳入标准，本研究纳入了50例患者：其中19例（11例三部分骨折和8例四部分骨折）采用肱骨近端髓内钉（HN）治疗，31例（12例三部分骨折和19例四部分骨折）采用锁定钢板（LP）接骨术治疗。根据赫特尔分类法进行分类。在1年随访时，比较两种治疗方法的并发症发生率。
20例患者（40%）至少发生了一种并发症。其中，6例患者（12%）接受了HN治疗，14例（28%）接受了LP治疗（p = 0.39）。最常见的并发症是螺钉穿出（22%），其次是骨不连（16%）。肱骨头坏死（10%）仅发生在LP组。1例接受HN治疗的患者发生了伤口感染。四部分骨折采用LP治疗的频率更高。然而，在本样本中差异无统计学意义（p = 0.186）。
我们的研究结果提供了一些证据，即在并发症发生率方面，肱骨近端三部分和四部分骨折内固定的两种治疗选择具有可比性。骨折类型似乎是植入物选择的决定性因素。
