이중 잠김 금속판을 이용한 골간단부 분쇄성이 동반된 상완골 근위부 골절의 골유합술

Abstract

Objectives: The purpose of this study is to evaluate the radiological results, clinical results, and complication rates of dual plate fixation for complex type metaphyseal fractures of proximal humerus.

Design: A retrospective, Case series. Setting: Academic Level II Trauma Center.

Patients/Participants: A trauma registry was utilized to identify 96 patients with proximal humerus fractures.

Intervention: Open reduction, internal fixation of complex proximal humerus fractures with a dual plate (N=18).

Main Outcome Measurements: Clinical results of University of California Los Angeles(UCLA) score and Constant scores were evaluated. Radiographic results were analyzed based on the duration of union. For evaluation of the degree of anatomical reduction, neck shaft angle (NSA) on the anteroposterior(AP) view of the simple plain radiography was measured using the Paavolainen method, and anterior-posterior angulation(APA) on axial view of plain radiograph or the saggital plane was measured on 3D-CT(3-dimensional computed tomography) images in the preoperative state, and recheck NSA and APA on the radiography in the postoperative state.

Results: The average UCLA score was 23 points. According to the results of Constant score, 18 patients in case reported average scores of 90.4. In case, the degree of anatomic reduction measured by the Paavolainen method was good in 14 patients (77.7%), fair in 3 patients (16.6%), and poor in 1 patient (5.6%). Patients in case showed a superior result than past other studies with single plate fixation. In our study, there was 1 case of impingement and 1 case of frozen shoulder, and no other serious complications were encountered

Conclusions: In patients with comminuted complex proximal humerus fractures, the use of dual locking plate provide stable fixation, preventing to complications such as varus collapse, anterior-posterior angulation, screw cutout, nonunion, malunion, and metal failure. Therefore, dual locking plate technique provide stable fixation and better clinical and radiological results and prevent complication.

Key words: Proximal humerus, Comminuted metaphyseal fractures, Dual plate fixation

Level of Evidence: Therapeutic Level III.