高齢者上腕骨頚部骨折の Impaction Method 併用 Philos plate 固定

抄録

The treatment for proximal humeral fractures (PHF) in older patients has been a challenging problem. The internal locked system (PHILOS) plate is a new device intended to give secure fixation of PHF. We retrospectively review the early functional and radiographic results of the impaction fixation of the humeral shaft into the humeral head in combination with PHILOS plate in a series of selected displaced PHF. The inclusion criteria for the study were 1) AO C type or B type with medial metaphyseal comminution 2) failed treatment including conservative or surgical, and 3) age older than 60 years. Between February 2006 and August 2008, 11 patients were treated surgically with the present method. There were 3 men and 8 women with the average age of 71 years (61-84 years). According to AO classification, there were 2 cases of A2, 2 cases of B1, 1 case of B2, and 6 cases of C2. The clinical assessment was performed by using the shoulder scoring system of the Japanese Orthopaedic Association. Radiographic evaluation was done for nonunion, avascular necrosis, and reduction loss. Follow up averaged 15 months (range; 6months- 3years 4 months). The mean clinical score was 87 % (range 77-97%). Mean Elevation, abduction, and mean external rotation were respectively 116, 111, and 34 degrees. All fractures healed. Screw cutout occurred in two cases, and varus subsidence occurred in two cases. There were no cases of infection, nerve injury, avascular necrosis, nonunion or implant failure. Our study demonstrated that for clinically severe cases of PHF, bone union with satisfactory results can be achieved using an impaction method in combination with PHILOS plate. Although the number reported here is small, the results are encouraging, and we believe that this method is a useful for challenging cases or older patients.