Jägerhuber Ludwig, Siebenbürger Georg, Fleischhacker Evi, Gibert Fabian, Böcker Wolfgang, Helfen Tobias
Department of Orthopaedics and Trauma Surgery, LMU University Hospital, LMU Munich, Germany.
JSES Int. 2024 Apr 27;8(5):921-925. doi: 10.1016/j.jseint.2024.04.010. eCollection 2024 Sep.
Locking plates are one of the most frequently used implants in surgical treatment of displaced proximal humeral fractures. In spite of this established implant and a standardized approach, reduced shoulder function might remain a mid-to long-term issue, furthermore scars may influence patient satisfaction as a cosmetic issue. Indications for a second surgery to remove implant and/or scar revision are common questions in this context.The aim of the present study was to assess the benefit of a second surgery, including implant removal and scar revision surgery, on patients' satisfaction under functional and cosmetic aspects.
Patients following displaced proximal humeral fractures treated by open reduction and internal fixation with a locking plate osteosynthesis via a delto-pectoral approach following implant removal were included retrospectively. A follow-up took place anamnestically before the incident or the primary surgery [A], before second surgery [B], and after second surgery (scar revision/implant removal) [C]. Functional outcome (Constant Score (CS)) of both shoulders was obtained using a patient-reported outcome measure to evaluate the contralateral side as well as percentage CS (%CS). Furthermore, the cosmetic outcome was evaluated for color, contour, and size.
The clinical data of n = 81 patients with displaced proximal humeral fractures and the consecutive open reduction and internal fixation with a locking plate (51 women = 63.0% and 30 men = 37.0%; mean age: 53.7 ± 16.6 years) via a standardized deltopectoral approach could be included. The mean CS) before sustaining the humeral fracture or primary surgery [A] was anamnestically 85.8 ± 8.5 points and %CS 99.4 ± 8.4%. After open reduction and internal with a locking plate osteosynthesis [B], the mean CS was 72.2 ± 9.1 points and %CS 84.5 ± 8.7%. Following the scheduled implant removal and scar revision [C], the CS was 80 ± 13.1 points and %CS 92.3 ± 14.1%. After primary surgery, 26 patients (32.1%) complained about the scar because of color, contour, or size before the second surgery, and 23 patients (28.4%) afterwards.
Implant removal after locking plate osteosynthesis in proximal humeral fractures via a delto-pectoral approach leads to an improved outcome both functionally and cosmetically. CS as well as scar situation and patients' overall satisfaction could be improved with a second surgery. Nevertheless, the need for a second surgery depends on the patients' functional and cosmetic demands.
锁定钢板是治疗移位性肱骨近端骨折手术中最常用的植入物之一。尽管有这种既定的植入物和标准化方法，但肩部功能下降可能仍是一个中长期问题，此外，疤痕作为一个美容问题可能会影响患者满意度。在这种情况下，二次手术取出植入物和/或进行疤痕修复的适应症是常见问题。本研究的目的是评估二次手术，包括植入物取出和疤痕修复手术，在功能和美容方面对患者满意度的益处。
回顾性纳入经三角肌胸大肌入路切开复位内固定并用锁定钢板进行骨合成治疗移位性肱骨近端骨折后取出植入物的患者。在事件或初次手术前[A]、二次手术前[B]以及二次手术（疤痕修复/植入物取出）后[C]进行回顾性随访。使用患者报告结局量表获取双肩的功能结局（Constant评分（CS）），以评估对侧以及CS百分比（%CS）。此外，对疤痕的颜色、轮廓和大小进行美容结局评估。
纳入了n = 81例移位性肱骨近端骨折患者的临床资料，这些患者通过标准化的三角肌胸大肌入路进行了切开复位内固定并用锁定钢板（51例女性 = 63.0%，30例男性 = 37.0%；平均年龄：53.7 ± 16.6岁）。在发生肱骨骨折或初次手术前[A]，回顾性随访的平均CS为85.8 ± 8.5分，%CS为99.4 ± 8.4%。切开复位并用锁定钢板进行骨合成后[B]，平均CS为72.2 ± 9.1分，%CS为84.5 ± 8.7%。在按计划取出植入物和进行疤痕修复后[C]，CS为80 ± 13.1分，%CS为92.3 ± 14.1%。初次手术后，26例患者（32.1%）在二次手术前因疤痕颜色、轮廓或大小而抱怨，23例患者（28.4%）在二次手术后抱怨。
经三角肌胸大肌入路对肱骨近端骨折进行锁定钢板骨合成后取出植入物在功能和美容方面均能改善结局。二次手术可改善CS、疤痕情况及患者的总体满意度。然而，是否需要二次手术取决于患者的功能和美容需求。
