RESUMEN

PURPOSE: To evaluate early functional outcomes of hemiarthroplasty for 3- or 4-part proximal humeral fractures. METHODS: 16 men and 11 women aged 27 to 83 (mean, 56) years underwent hemiarthroplasty for comminuted 3-part (n=13) or 4-part (n=14) proximal humeral fractures. All the patients reported normal shoulder function prior to injury. The range of shoulder motion and muscle power were evaluated, as were subjective pain and satisfaction (using the UCLA scoring system). RESULTS: At the final follow-up, the mean maximum abduction was 111º (SD, 47º; range, 30º-180º), and the mean maximum forward flexion was 143º (SD, 41º; range, 45º-180º). All patients had radiographic union of the tuberosities. The mean UCLA score was 28; 21 patients attained good-to-excellent scores (≥27), whereas 6 attained lower (fair-to-poor) scores. The mean UCLA score was higher in patients aged <60 (n=13) than those who were older (n=14) [30 vs. 26, p=0.008] and in patients operated after 7 days (n=6) than those operated before 7 days (n=21) [32 vs. 27, p=0.02], but did not differ significantly in terms of gender and fracture type and side. Patient age and gender, fracture type, and injury-to-surgery interval did not have a significant impact on maximum forward flexion and abduction. CONCLUSION: Early functional outcomes of hemiarthroplasty for comminuted proximal humeral fractures is good in medically fit and cooperative patients.

Asunto(s)

Artroplastia de Reemplazo/métodos , Fracturas Conminutas/cirugía , Fracturas del Hombro/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Rango del Movimiento Articular , Recuperación de la Función , Fracturas del Hombro/fisiopatología , Articulación del Hombro/fisiopatología , Resultado del Tratamiento

RESUMEN

BACKGROUND: In cases with infected non-union, the primary step is eradication of the infection before attempting to achieve union. Release of antibiotics from the bone cement at a high concentration and its penetration to the surrounding tissues, including cortical and cancellous bone, prompted the use of antibiotic cement in the control of bone infection. The aim of this study is to summarize our experience with the use of antibiotic cement-impregnated intramedullary nail (ACIIN) for control of infection in cases of infected non-union with bone defect. MATERIALS AND METHODS: We prospectively studied 25 cases of infected non-union (23 femora and two tibiae). There were 24 males and one female, with the mean age being 33 years (range, 21-58 years). All patients had high-velocity road traffic accidents except one patient who had farmland injury. There were seven closed fractures, one grade I compound, two grade II compound fractures, five grade IIIA compound fractures, and 10 grade IIIB compound fractures. ACIIN was used in all cases after adequate debridement. Patients were classified according to the amount of bone defect present after debridement: group 1 with bone defect <4 cm (n=13), group 2 with bone defect >/=4-<6 cm (n=7), and group 3 with bone defect >/=6 cm (n=5). Infection control was judged on the basis of discharge through the wound and laboratory parameters. All patients were followed-up, with an average follow-up time of 29 months (range, 18-40 months). The mean duration of retention of the intramedullary rod was 8 weeks (range, 6-12 weeks). RESULTS: In group 1, all cases achieved infection control, with three patients achieving bone union without any need of secondary procedure. In group 2, all cases achieved infection control but the time taken was significantly longer than for group 1 (P value 0.0002). All the cases required a secondary procedure in the form of either interlocking intramedullary nailing with iliac crest bone graft or Ilizarov ring fixator application to achieve union. None of the cases in group 3 achieved infection control. CONCLUSION: ACIINs are useful for infection control in cases of infected non-union with bone defect <6 cm. In cases with defect >6 cm, other alternatives should be used.