Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
권호 표지
DOI QR코드

DOI QR Code

상완골 근위부 골절에 시행한 긴장 대 봉합을 동반한 관혈적 골수강내 고정술

Open Intramedullary Nail with Tension Band Sutures on Proximal Humeral Fracture

  • 박진영 (단국대학교 의과대학 정형외과학교실) ;
  • 안진우 (단국대학교 의과대학 정형외과학교실) ;
  • 이성철 (단국대학교 의과대학 정형외과학교실)
  • Park, Jin-Young (Department of Orthopedic Surgery Dankook Universiy college of Medicine) ;
  • An, Jin-Woo (Department of Orthopedic Surgery Dankook Universiy college of Medicine) ;
  • Lee, Sung-Churl (Department of Orthopedic Surgery Dankook Universiy college of Medicine)
  • 발행 : 2003.12.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: to determine the results after open intramedullary nailing and tension band suture technique in proximal humerus fracture for improving the stability and decreasing the complications. Materials and Method: Authors reviewed 27 patients treated by open intramedullary nailing and tension band suture technique. Mean follow-up period was 39 months (24-59months). Surgical neck fracture were 6 cases, surgical neck fracture with shaft fracture were 3 cases, three part fracture with greater tuberosity fracture were 17 cases, four part fracture was 1 case and fracture and dislocation were 2 cases Results: We got the bony union in 26 cases. Average pain scale was 1 point (0-6), Neer score was 86 point(45-99) and ASES score was 85 point(40-100). We separate all cases in two groups based on age (65 years), L-spine t-score (-2.5) and Neer classification (2 and 3 part). There is no significance in pain scale, Neer score and ASES score between each group. Conclusion: As a method of surgical treatment on severe proximal humeral fractures, we recommend intramedullary nailing and tension band suture technique and it may have particular advantages in early exercise and satisfactory functional outcome.

키워드

참고문헌

  1. Adedapo, A. O., and Ikpeme, J. O.: The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury, 32(2):115-21, 2001.
  2. Baron, J. A.; Karagas, M.; Barrett, J.; Kniffin, W.; Malenka, D.; Mayor, M.; and Keller, R. B.: Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology, 7(6):612-8, 1996. https://doi.org/10.1097/00001648-199611000-00008
  3. Bigliani, L.: Proximal Humeral Fracture. In The Shoulder -Operative technique-, pp. 43-71. Edited by Pollock, R., 43-71, Baltimore, Maryland, Williams & Wilkins, 1998.
  4. Boileau, P., and Walch, G.: The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br, 79(5):857-65, 1997. https://doi.org/10.1302/0301-620X.79B5.7579
  5. Brooks, C. H., and Carvell, J. E.: External fixation for fracture-dislocations of the proximal humerus. J Bone Joint Surg Br, 71(5):864-5, 1989.
  6. Chapman, J. R.; Henley, M. B.; Agel, J.; and Benca, P. J.: Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma, 14(3):162-6, 2000. https://doi.org/10.1097/00005131-200003000-00002
  7. Christensen, N. O.: Kuntscher intramedullary reaming and nail fixation for nonunion of the humerus. Clin Orthop, (116):222-5, 1976.
  8. Cofield, R. H.: Comminuted fractures of the proximal humerus. Clin Orthop, (230): 49-57, 1988.
  9. Cox, M. A.; Dolan, M.; Synnott, K.; and McElwain, J. P.: Closed interlocking nailing of humeral shaft fractures with the Russell-Taylor nail. J Orthop Trauma, 14(5):349-53, 2000. https://doi.org/10.1097/00005131-200006000-00008
  10. Crates, J., and Whittle, A. P.: Antegrade interlocking nailing of acute humeral shaft fractures. Clin Orthop, (350):40-50, 1998.
  11. Cuomo, F.; Flatow, E.; Maday, M.; Miller, S.; Stephen, J.; and Bigliani, L.: Open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus. J Shoulder Elbow Surg, 1(6):287-295, 1992. https://doi.org/10.1016/S1058-2746(09)80055-4
  12. Esser, R. D.: Treatment of three- and four-part fractures of the proximal humerus with a modified cloverleaf plate. J Orthop Trauma, 8(1):15-22, 1994. https://doi.org/10.1097/00005131-199402000-00005
  13. Fleischmann, W., and Kinzl, L.: Philosophy of osteosynthesis in shoulder fractures. Orthopedics, 16(1):59-63, 1993.
  14. Habernek, H.: A locking nail for fractures of the humerus. J Bone Joint Surg Br, 80(3):557, 1998.
  15. Habernek, H., and Orthner, E.: A locking nail for fractures of the humerus. J Bone Joint Surg Br, 73(4):651-3, 1991.
  16. Hall, R. F., Jr.: Closed intramedullary fixation of humeral shaft fractures. Instr Course Lect, 36:349-58, 1987.
  17. Hawkins, R. J., and Angelo, R. L.: Displaced proximal humeral fractures. Selecting treatment, avoiding pitfalls. Orthop Clin North Am, 18(3):421-31, 1987.
  18. Hawkins, R. J., and Kiefer, G. N.: Internal fixation techniques for proximal humeral fractures. Clin Orthop, (223):77-85, 1987.
  19. Hems, T. E., and Bhullar, T. P.: Interlocking nailing of humeral shaft fractures: the Oxford experience 1991 to 1994. Injury, 27(7):485-9, 1996. https://doi.org/10.1016/0020-1383(96)00056-3
  20. Henley, M. B.; Monroe, M.; and Tencer, A. F.: Biomechanical comparison of methods of fixation of a midshaft osteotomy of the humerus. J Orthop Trauma, 5(1):14-20, 1991. https://doi.org/10.1097/00005131-199103000-00003
  21. Hintermann, B.; Trouillier, H. H.; and Schafer, D.: Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br, 82(8):1107-12, 2000. https://doi.org/10.1302/0301-620X.82B8.10330
  22. Ikpeme, J. O.: Intramedullary interlocking nailing for humeral fractures: experiences with the Russell-Taylor humeral nail. Injury, 25(7):447-55, 1994. https://doi.org/10.1016/0020-1383(94)90271-2
  23. Ingman, A. M., and Waters, D. A.: Locked intramedullary nailing of humeral shaft fractures. Implant design, surgical technique, and clinical results. J Bone Joint Surg Br, 76(1):23-9, 1994.
  24. Jaberg, H.; Warner, J. J.; and Jakob, R. P.: Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg Am, 74(4):508-15, 1992.
  25. Jensen, C. H.; Hansen, D.; and Jorgensen, U.: Humeral shaft fractures treated by interlocking nailing: a preliminary report on 16 patients. Injury, 23(4):234-6, 1992. https://doi.org/10.1016/S0020-1383(05)80005-1
  26. Ko, J. Y., and Yamamoto, R.: Surgical treatment of complex fracture of the proximal humerus. Clin Orthop, (327):225-37, 1996.
  27. Kocialkowski, A., and Wallace, W. A.: Closed percutaneous K-wire stabilization for displaced fractures of the surgical neck of the humerus. Injury, 21(4):209-12, 1990. https://doi.org/10.1016/0020-1383(90)90003-D
  28. Koval, K.; Sanders, R.; Zuckerman, J.; Helfet, D.; Kummer, F.; and DiPasquale, T.: Modified-tension band wiring of displaced surgical neck fractures of the humerus. J Shoulder Elbow Surg, 2(2):85-92, 1993. https://doi.org/10.1016/1058-2746(93)90005-2
  29. Koval, K. J.; Blair, B.; Takei, R.; Kummer, F. J.; and Zuckerman, J. D.: Surgical neck fractures of the proximal humerus: a laboratory evaluation of ten fixation techniques. J Trauma, 40(5):778-83, 1996. https://doi.org/10.1097/00005373-199605000-00017
  30. Kristiansen, B., and Christensen, S. W.: Plate fixation of proximal humeral fractures. Acta Orthop Scand, 57(4):320-3, 1986. https://doi.org/10.3109/17453678608994401
  31. Kristiansen, B., and Christensen, S. W.: Proximal humeral fractures. Late results in relation to classification and treatment. Acta Orthop Scand, 58(2):124-7, 1987. https://doi.org/10.3109/17453678709146455
  32. Kristiansen, B., and Kofoed, H.: Transcutaneous reduction and external fixation of displaced fractures of the proximal humerus. A controlled clinical trial. J Bone Joint Surg Br, 70(5):821-4, 1988.
  33. Lin, J., and Hou, S. M.: Antegrade locked nailing for humeral shaft fractures. Clin Orthop, (365):201-10, 1999.
  34. Lin, J.; Hou, S. M.; and Hang, Y. S.: Locked nailing for displaced surgical neck fractures of the humerus. J Trauma, 45(6):1051-7, 1998. https://doi.org/10.1097/00005373-199812000-00013
  35. Lin, J.; Hou, S. M.; Hang, Y. S.; and Chao, E. Y.: Treatment of humeral shaft fractures by retrograde locked nailing. Clin Orthop, (342):147-55, 1997.
  36. Lin,J.; Hou,S.M.; Inoue,N.; Chao,E. Y.; and Hang, Y. S.: Anatomic considerations of locked humeral nailing. Clin Orthop, (368):247-54, 1999.
  37. Mills, H. J., and Horne, G.: Fractures of the proximal humerus in adults. J Trauma, 25(8):801-5, 1985. https://doi.org/10.1097/00005373-198508000-00013
  38. Moda, S. K.; Chadha, N. S.; Sangwan, S. S.; Khurana, D. K.; Dahiya, A. S.; and Siwach, R. C.: Open reduction and fixation of proximal humeral fractures and fracture-dislocations. J Bone Joint Surg Br, 72(6):1050-2, 1990.
  39. Neer, C. S., 2nd: Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am, 52(6):1077-89, 1970.
  40. Neer, C. S., 2nd: Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am, 52(6):1090-103, 1970.
  41. Paavolainen, P.; Bjorkenheim, J. M.; Slatis, P.; and Paukku, P.: Operative treatment of severe proximal humeral fractures. Acta Orthop Scand, 54(3):374-9, 1983. https://doi.org/10.3109/17453678308996587
  42. Philips, B.: Arthroscopy of upper extremity. In Campbell's operative orthopaedics, pp. 2613-2665. Edited by Canale, S., 2613-2665, Philadelphia, Pennsylvania, Mosby, 2003.
  43. Rajasekhar, C.; Ray, P. S.; and Bhamra, M. S.: Fixation of proximal humeral fractures with the Polarus nail. J Shoulder Elbow Surg, 10(1):7-10, 2001. https://doi.org/10.1067/mse.2001.109556
  44. Rees, J.; Hicks, J.; and Ribbans, W.: Assessment and management of three-and four-part proximal humeral fractures. Clin Orthop, (353):18-29, 1998.
  45. Richards, R. et al.: A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg, 3(6):347-352, 1994. https://doi.org/10.1016/S1058-2746(09)80019-0
  46. Riemer, B. L.; Butterfield, S. L.; D'Ambrosia, R.; and Kellam, J.: Seidel intramedullary nailing of humeral diaphyseal fractures: a preliminary report. Orthopedics, 14(3):239-46, 1991.
  47. Robinson, C. M.; Bell, K. M.; Court-Brown, C. M.; and McQueen, M. M.: Locked nailing of humeral shaft fractures. Experience in Edinburgh over a two-year period. J Bone Joint Surg Br, 74(4):558-62, 1992.
  48. Robinson, C. M., and Christie, J.: The two-part proximal humeral fracture: a review of operative treatment using two techniques. Injury, 24(2):123-5, 1993. https://doi.org/10.1016/0020-1383(93)90204-J
  49. Ruch, D. S.; Glisson, R. R.; Marr, A. W.; Russell, G. B.; and Nunley, J. A.: Fixation of three-part proximal humeral fractures: a biomechanical evaluation. J Orthop Trauma, 14(1):36-40, 2000. https://doi.org/10.1097/00005131-200001000-00008
  50. Rush, L.: The humerus. In Atlas of Rush Pin Technics. A System of Fracture Treatment, pp. 112-133. Edited by LV, R., 112-133, Meridian, Mississippi, Berivon, 1976.
  51. Szyszkowitz, R.; Seggl, W.; Schleifer, P.; and Cundy, P. J.: Proximal humeral fractures. Management techniques and expected results. Clin Orthop, (292):13-25, 1993.
  52. Wachtl, S. W.; Marti, C. B.; Hoogewoud, H. M.; Jakob, R. P.; and Gautier, E.: Treatment of proximal humerus fracture using multiple intramedullary flexible nails. Arch Orthop Trauma Surg, 120(3-4):171-5, 2000. https://doi.org/10.1007/s004020050037
  53. Weinstein, D.; Gomez, M.; and Hawkins, R.: Biomechanical comparison of tension band wiring versus plating in the fixation of three part fractures of the proximal humerus. Orthop Trans, 18:3, 1994.
  54. Wesely, M.; Barenfield, P.; and Eisenstein, A.: Rush pin intramedullary fixation for fractures of proximal humeus. J Trauma, 17(1):29-33, 1977. https://doi.org/10.1097/00005373-197701000-00004
  55. Young, T. B., and Wallace, W. A.: Conservative treatment of fractures and fracture-dislocations of the upper end of the humerus. J Bone Joint Surg Br, 67(3):373-7, 1985.
  56. Zyto, K.; Ahrengart, L.; Sperber, A.; and Tornkvist, H.: Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br, 79(3):412-7, 1997. https://doi.org/10.1302/0301-620X.79B3.7419

피인용 문헌

  1. Open Intramedullary Nail with Tension Band Sutures & Lock Sutures on Proximal Humeral Three-part Fracture vol.20, pp.1, 2007, https://doi.org/10.12671/jkfs.2007.20.1.45