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Obere Extremität

, Volume 3, Issue 4, pp 178–186 | Cite as

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

  • J Theopold
  • P Hepp
  • T Engel
  • B Marquaß
  • C Leihe
  • C Josten
Originalarbeit
  • 54 Downloads

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.

Schlüsselwörter

Proximale Humerusfraktur Winkelstabile Plattenosteosynthese EMG Cybex Oberflächenableitung 

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

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.

Keywords

Proximal humerus fracture Locking plate EMG Cybex Surface activity measurement  

Notes

Interessenkonflikt

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Literatur

  1. 1.
    Apaydin N, Uz A, Bozkurt M, Elhan A (2007) The anatomic relationships of the axillary nerve and surgical landmarks for its localization from the anterior aspect of the shoulder. Clin Anat 20(3):273–277CrossRefPubMedGoogle Scholar
  2. 2.
    Bathis H, Tingart M, Bouillon B, Tiling T (2001) Surgical treatment of proximal humeral fractures. Is the T-plate still adequate osteosynthesis procedure?. Zentralbl Chir 126(3):211–216CrossRefPubMedGoogle Scholar
  3. 3.
    Bjorkenheim JM, Pajarinen J, Savolainen V (2004) Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand 75(6):741–745CrossRefPubMedGoogle Scholar
  4. 4.
    Blum J, Rommens PM (2002) Proximale Verriegelung von Humerusmarknageln und Verletzungsrisiko des N. axillaris. Unfallchirurg 105(1):9–13CrossRefPubMedGoogle Scholar
  5. 5.
    Bono CM, Grossman MG, Hochwald N, Tornetta P 3rd (2000) Radial and axillary nerves. Anatomic considerations for humeral fixation. Clin Orthop Relat Res (373):259–264Google Scholar
  6. 6.
    Charalambous CP, Siddique I, Valluripalli K et al (2007) Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 127(3):205–210CrossRefPubMedGoogle Scholar
  7. 7.
    Chudik SC, Weinhold P, Dahners LE (2003) Fixed-angle plate fixation in simulated fractures of the proximal humerus: a biomechanical study of a new device. J Shoulder Elbow Surg 12(6):578–588CrossRefPubMedGoogle Scholar
  8. 8.
    Cole PA, Zlowodzki M, Kregor PJ (2003) Less Invasive Stabilization System (LISS) for fractures of the proximal tibia: indications, surgical technique and preliminary results of the UMC Clinical Trial. Injury 34 Suppl 1:A16–29CrossRefPubMedGoogle Scholar
  9. 9.
    Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371CrossRefPubMedGoogle Scholar
  10. 10.
    Fankhauser F, Boldin C, Schippinger G et al (2005) A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res (430):176–181Google Scholar
  11. 11.
    Gallo RA, Zeiders GJ, Altman GT (2005) Two-incision technique for treatment of complex proximal humerus fractures. J Orthop Trauma 19(10):734–740CrossRefPubMedGoogle Scholar
  12. 12.
    Gardner MJ, Griffith MH, Dines JS et al (2005) The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. Clin Orthop Relat Res (434):123–129Google Scholar
  13. 13.
    Hata Y, Saitoh S, Murakami N et al (2004) Atrophy of the deltoid muscle following rotator cuff surgery. J Bone Joint Surg 86A(7):1414–1419CrossRefGoogle Scholar
  14. 14.
    Hente R, Kampshoff J, Kinner B et al (2004) Die Versorgung dislozierter 3- und 4-Fragmentfrakturen des proximalen Humerus mit einem winkelstabilen Plattenfixateur. Unfallchirurg 107(9):769–782CrossRefPubMedGoogle Scholar
  15. 15.
    Hepp P, Theopold J, Voigt C et al (2008) The surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome. J Shoulder Elbow Surg 17(1):21–28CrossRefPubMedGoogle Scholar
  16. 16.
    Hessmann MH, Hansen WS, Krummenauer F et al (2005) Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation. J Trauma 58(6):1194–1201CrossRefPubMedGoogle Scholar
  17. 17.
    Kannus P, Palvanen M, Niemi S et al (2000) Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970–1998 and alarming projections for the new millennium. Acta Orthop Scand 71(5):465–470CrossRefPubMedGoogle Scholar
  18. 18.
    Kontakis GM, Steriopoulos K, Damilakis J, Michalodimitrakis E (1999) The position of the axillary nerve in the deltoid muscle. A cadaveric study. Acta Orthop Scand 70(1):9–11CrossRefPubMedGoogle Scholar
  19. 19.
    Koukakis A, Apostolou CD, Taneja T et al (2006) Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res 442:115–120CrossRefPubMedGoogle Scholar
  20. 20.
    Lewicky YM, Sheppard JE, Ruth JT (2007) The combined olecranon osteotomy, lateral paratricipital sparing, deltoid insertion splitting approach for concomitant distal intra-articular and humeral shaft fractures. J Orthop Trauma 21(2):133–139CrossRefPubMedGoogle Scholar
  21. 21.
    Lill H, Hepp P, Korner J et al (2003) Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 123(2-3):74–81CrossRefPubMedGoogle Scholar
  22. 22.
    Lill H, Hepp P, Rose T et al (2004) Die winkelstabile Plattenosteosynthese (LPHP) proximaler Humerusfrakturen über den kleinen anterolateralen Delta-Splitting-Zugang - Technik und erste Ergebnisse. Zentralbl Chir 129(1):43–48CrossRefPubMedGoogle Scholar
  23. 23.
    Lin J, Hou SM, Inoue N et al (1999) Anatomic considerations of locked humeral nailing. Clin Orthop Relat Res (368):247–254Google Scholar
  24. 24.
    Monoot P, Ashwood N, Hamlet M (2007) Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg Br 89:1206–1209CrossRefGoogle Scholar
  25. 25.
    Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52(6):1077–1089CrossRefPubMedGoogle Scholar
  26. 26.
    Perlmutter GS (1999) Axillary nerve injury. Clin Orthop Relat Res (368):28–36Google Scholar
  27. 27.
    Perren SM (2002) Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 84(8):1093–1110CrossRefPubMedGoogle Scholar
  28. 28.
    Plecko M, Kraus A (2005) Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol 17(1):25–50CrossRefPubMedGoogle Scholar
  29. 29.
    Rommens PM, Blum J, Runkel M (1998) Retrograde nailing of humeral shaft fractures. Clin Orthop Relat Res (350):26–39Google Scholar
  30. 30.
    Schütz M, Kolbeck S, Spranger A et al (2003) Palmar plating with the locking compression plate for dorsally displaced fractures of the distal radius–first clinical experiences. Zentralbl Chir 128(12):997–1002CrossRefPubMedGoogle Scholar
  31. 31.
    Schütz M, Müller M, Kääb M, Haas N (2003) Less invasive stabilization system (LISS) in the treatment of distal femoral fractures. Acta Chir Orthop Traumatol Cech 70(2):74–82PubMedGoogle Scholar
  32. 32.
    Smith AM, Mardones RM, Sperling JW, Cofield RH (2006) Early complications of operatively treated proximal humeral fractures. J Shoulder Elbow Surg Google Scholar
  33. 33.
    Smith AM, Mardones RM, Sperling JW, Cofield RH (2007) Early complications of operatively treated proximal humeral fractures. J Shoulder Elbow Surg 16(1):14–24CrossRefPubMedGoogle Scholar
  34. 34.
    Strohm PC, Köstler W, Südkamp NP (2005) Locking plate fixation of proximal humerus fractures. Techniques in Shoulder and Elbow Surgery 6(1):8–13Google Scholar
  35. 35.
    Sturzenegger M, Fornaro E, Jakob RP (1982) Results of surgical treatment of multifragmented fractures of the humeral head. Arch Orthop Trauma Surg 100(4):249–259CrossRefPubMedGoogle Scholar
  36. 36.
    Traxler H, Surd R, Laminger KA et al. (2001) The treatment of subcapital humerus fracture with dynamic helix wire and the risk of concommitant lesion of the axillary nerve. Clin Anat 14(6):418–423CrossRefPubMedGoogle Scholar
  37. 37.
    Voigt C, Woltmann A, Partenheimer A, Lill H (2007) Komplikationsmanagement nach winkelstabiler Plattenosteosynthese am proximalen Humerus. Chirurg 78(1):40–46CrossRefPubMedGoogle Scholar
  38. 38.
    Weinstein DM, Bratton DR, Ciccone WJ 2nd, Elias JJ (2006) Locking plates improve torsional resistance in the stabilization of three-part proximal humeral fractures. J Shoulder Elbow Surg 15(2):239–243CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • J Theopold
    • 1
  • P Hepp
    • 1
  • T Engel
    • 1
  • B Marquaß
    • 1
  • C Leihe
    • 2
  • C Josten
    • 1
  1. 1.Chirurgische Klinik I, Klinik für Unfall- Wiederherstellungs- und Plastische ChirurgieUniversität LeipzigLeipzigGermany
  2. 2.MEDICA Klinik (Chefarzt: Dr. med J. Ulrich)LeipzigGermany

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