Riassunto
Vengono presentati i risultati del trattamento chirurgico mediante osteosintesi interna di 107 casi di fratture omerali complesse che si estendono dall’epifisi prossimale al 1/3 medio diafisario. L’intrinseca difficoltà di posizionamento di una placca lunga, relativamente alla necessità di non danneggiare strutture vascolo-nervose e muscolari, ha determinato la scelta, come via di accesso, della via transdeltoidea laterale. Tutte le fratture trattate sono giunte a consolidazione senza procedure accessorie mediamente in 20 settimane. La valutazione clinico-funzionale numerica secondo il Costant score ha evidenziato un progressivo miglioramento con un indice medio di 83 punti. La valutazione analogica del dolore (VAS) ha evidenziato un netto miglioramento a partire dal 6° mese post-operatorio con un indice massimo di 13,5 punti su 15. In 6 casi (6,42%) si è registrata intolleranza al mezzo di sintesi correlata in 1 caso a dolore al passaggio deltoideo-brachiale e nei rimanenti 5 a “fastidio” di origine psicologica. In 11 casi (11,77%) si è riscontrato un conflitto sottoacromiale del mezzo di sintesi che però non ha determinato la rimozione dello stesso prima della consolidazione ossea. Tutti i pazienti sono stati sottoposti a rimozione del mezzo di sintesi ad almeno 12 mesi dall’impianto.
Abstract
The authors present the results of surgical treatment by internal osteosynthesis of 107 cases of complex humeral fractures that extend from the proximal humeral epiphysis to the 1/3 medium-diaphyseal. The necessity to avoid damage to nerve, muscle and vascular structures, and inherent difficulty of placing a long plate, has determined the choice of the translateral deltoid approach. All treated fractures have reached bone consolidation in 20 weeks, on average, without ancillary procedures. The clinical functional evaluation according to the Constant numerical score showed a progressive improvement with an average index of 83 points. The analogic pain assessment (VAS) showed a marked improvement from 6 months after surgery, with a maximum of 13.5 points out of 15. In 6 cases (6.42%) a plate-related intolerance was reported: in 1 case pain was due to the passage of the long plate under the deltoid brachial insertion; in the remaining cases pain origin was deemed as psychological. In 11 cases (11.77%) a subacromial conflict of plate was observed; however, it did not result in removal of the same prior to bone consolidation. All patients underwent removal of the plates no earlier than 12 months after surgery.
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Accetta, R., Gaietta, D., Meersseman, A. et al. Il trattamento delle fratture prossimali e del terzo medio diafisario dell’omero con placche a stabilizzazione angolare. Aggiornamenti 17, 7–10 (2011). https://doi.org/10.1007/s10351-011-0002-9
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DOI: https://doi.org/10.1007/s10351-011-0002-9