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3-Jahres Ergebnisse nach winkelstabiler Plattenosteosynthese am proximalen Humerus unter besonderer Berücksichtigung elektromyographischer Befunde

3-Year results after locking plate osteosynthesis of proximal humerus fractures under special consideration of electromyographic results

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Zusammenfassung

Einleitung

Ziel der Studie war es mittelfristige funktionelle und radiologische Ergebnisse unter Einbeziehung einer Oberflächenaktivitätsmessung nach operativer Versorgung proximaler Humerusfrakturen mittels winkelstabiler Plattenosteosynthese zu erhalten.

Patienten und Methoden

Im Rahmen einer prospektiven Studie (2003-2005) (EBA Level IIa) wurden 39 Patienten eingeschlossen (Alter Mittel 64 Jahre, min 18-max 88). 23 Patienten (59%) konnten nach 3 Jahren (min 20-max 41 Monaten) erneut untersucht werden. (Constant, Dash und Neer Score). Alle Patienten wurden über den anterolateralen Deltasplitting-Zugang operiert. Bei 14 Patienten (60%) erfolgte eine muskuläre Oberflächenaktivitätsmessung.

Ergebnisse

Im Constant Score zeigt sich nach 3 Monaten ein befriedigendes Ergebnis (mittel 64,5 (56-70 Punkte)) im Vergleich zu den guten Ergebnissen nach einem Jahr (mittel 75,7 (71-85 Punkte)). Bei der 3 Jahres Untersuchung kam es nochmals zu einer Verbesserung der guten Ergebnisse (mittel 80,5). In der isokinetischen Untersuchung der Abduktion bestand eine Kraftminderung der verletzten Seite um 40%. Es kam zu einer Aktivitätssteigerung im Bereich des M. trapezius (142%). Die Adduktion zeigte eine geringere Kraftminderung der verletzten Seite.

Schlussfolgerung

Es kommt drei Jahre nach operativer Versorgung zu einer Verbesserung des funktionellen Ergebnisses im Vergleich zu der Untersuchung nach einem Jahr, insbesondere der Beweglichkeit. Im Bereich des Schultergürtels scheint es zu Kompensationsmechanismen der Schulterhilfsmuskulatur zu kommen.

Abstract

Introduction

This study aimed to obtain medium-term results of functional outcome after surgical treatment of proximal humerus fractures with the locking plate osteosynthesis. In addition, we focused on radiological and surface electromyographic results.

Patients and methods

In this prospective clinical trial (from 2003-2005, EBA Level IIa), 39 patients were included (average age: 64 yrs, range: 18-88). A total of 23 patients (59%) were re-examined after 3 years (range 20-41 months)(Constant, Dash and Neer Scores). The anterolateral delta splitting approach was used on all patients. A muscular surface activity measurement was performed in 14 patients (60%).

Results

After 3 months the Constant score showed satisfactory results (average 64.5) compared to the results after one year (average 75.7). Re-examination after 3 years proved increasing results (average 80.5). The isokinetic examination of abduction showed a loss of strength of 40% on the injured side as well as an increased activity in the area of M. trapezius (142%). Adduction showed less loss of strength on the injured side.

Conclusion

Three years after operation, the functional results improve, especially with regard to mobility. In the area of the shoulder girdle compensation mechanisms of the accessory muscles seem to occur.

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Authors and Affiliations

  1. Chirurgische Klinik I, Klinik für Unfall- Wiederherstellungs- und Plastische Chirurgie, Universität Leipzig, Liebigstr. 20, 04103, Leipzig, Germany

    J Theopold, P Hepp, T Engel, B Marquaß &  C Josten

  2. MEDICA Klinik (Chefarzt: Dr. med J. Ulrich), Leipzig, Germany

    C Leihe

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  1. J Theopold
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  2. P Hepp
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  3. T Engel
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  4. B Marquaß
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  5. C Leihe
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  6. C Josten
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Correspondence to J Theopold.

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Theopold, J., Hepp, P., Engel, T. et al. 3-Jahres Ergebnisse nach winkelstabiler Plattenosteosynthese am proximalen Humerus unter besonderer Berücksichtigung elektromyographischer Befunde. Obere Extremität 3, 178–186 (2008). https://doi.org/10.1007/s11678-008-0001-9

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