بررسي نتايج درماني شكستگيهاي 3 و4 قطعه اي قسمت فوقاني استخوان بازو به روش بخيه زدن قطعات به يكديگر

ASSESSMENT OF THE RESULTS OF TREATING THREE AND FOUR-PART FRACTURES OF THE PROXIMAL HUMERUS WITH TRANSOSSEUS SUTURE FIXATION TECHNIQUE(TOSF)

Optimal treatment of 3 and 4-part fractures of the proximal humerus is still controversial and is accompanied with many complications. These fractures can be treated with variety of osteosynthetic methods especially in younger ages, but some complications such as limited range of motions, malunions and avascular necrosis are common. Hemiarthroplasty can be used in old patients with low activity or in severely comminuted fractures, but this is an expensive method and has major limitations in undeveloped or developing countries. In this article the results of TOSF technique are presented. 28 patients with 3 or 4-part fractures or fracture dislocations of the proximal humerus were treated with TOSF technique from 1996 to 2002. 3 cases were excluded from the study and the 25 remaining ones were assessed. The mean age was 43.2 years(20-68 years) and the duration of follow-up was 39 months(3 months to 6 years). Preoperative diagnosis was based on plain radiographs and CT-Scans. Fixation was made with non-absorbable or late absorbable sutures(no.5-USP) and a range of motion exercises began immediately after the surgery according to patientsʹ tolerance. The obtained data from the latest clinical and radiographical examination was then analysed. In one patient the greater tuberosity was nonunioned. Also, no neurovascular injury during operation, no infection and no avascular necrosis was found. Malunion rate was 32%. The average range of motion was 157° in flexion, 21° in extension, 31° in external rotation, 132° in abduction and in internal rotation it was up to L2-L3. Satisfaction from surgery according to Neerʹs rating system was 64% excellent, 20% satisfactory, 12% unsatisfactory and 4% failure. Returning to previous job was 72%. Thus, TOSF technique for treatment of these fractures has acceptable results with minimal complications, and it can be used in all age group with severely comminuted fractures or osteoporosis. Also, this treatment is a reasonable substitute for hemiarthroplasty in undeveloped or developing countries.