الفهرس | Only 14 pages are availabe for public view |
Abstract - Between the period of February 2012 and February 2016, a prospective study of twenty patients with post traumatic comminuted fracture proximal humerus with or without dislocation of the humeral head had been admitted to El- Menoufia University Hospital. .Certain inclusion criteria were used for inclusion of the patients in this study including criteria in the patients and criteria related to the fracture type. Exclusion of revision arthroplasty cases and unfit patients form the study. All cases included in the study fulfill the inclusion criteria. Full history and clinical examination were done for all cases of the study. The age of this group ranges between 52to 75 years, with six males and 14 females. Twelve cases were house wife, 2 were civil servant, 2 retired, one lecturer and one taxi driver. Twelve cases of the study had chronic medical problems which are controlled prior to sugery.The study include two cases had previous trauma to shoulder and they were included in the study after exclusion of the infection and nerve injury. The cause of trauma was low energy trauma in 12 cases and high energy trauma was in 8 cases and one case had associated injury . Right shoulder was affected in 16 cases while left shoulder was affected in 4 cases.14 cases were four-part fracture,5 cases were three part fracture and one case was two part fracture. Time gab between trauma and operation varies from one week up to twenty four weeks. Radiological investigations including X-ray and CT were done for all cases of the study. MRI needed only in one case. EMG was needed in one case. - Pre-operative antibiotic protocol was used .General anesthesia was used for all cases of the study. Beach chair position and delto-pectoral approach was used in all cases of the study .Identification of biceps tendons with identification of lesser and greater tuberosities were done. Proper sizing of the stem and the head of the prosthesis was done. Repair of the tendons to the prosthesis and bone were done. Eight cases need blood transfusion. Repair of rotator cuff tendons by trans-osseous sutures in 17 cases and directly to the prosthesis fins in 3 cases.Bicepes tenodesis were done in 13 cases. 2 cases had partial tear of rotator cuff tendons which was discovered during operation and repair of tendon were done with non-absorbable sutures. The stem diameter ranged from 7 to 10 mm and the head diameter ranged from 42 to 46mm.16 cases had prosthesis with central offset and 4 cases had prosthesis with eccentric offset. The operative time ranged from 1.5 to2.5 hours. There were no intra-operative complications during surgery. - -Single post-operative protocol was used in all cases of the study in terms of antibiotic regimen, hospital stay and rehabilitation protocol. The follow-up visits were scheduled at 2 weeks, 6 weeks, 3 months, 6 months, 1 year post-operatively. The cases of the study were assessed clinically in terms of range of motion, constant score and satisfaction score. Radiological evaluation was done by follow up X-rays to assess cement mantle, tuberosities union and tendon repair. - Post-operative range of motion ranges from 20 degrees to 105 degrees, from 10 degrees to 95 degrees in abduction, from 10 degrees to 40 degrees in extension and from 10 degrees to 40 degrees in adduction. Post –operative results were assessed by constant score. 2 cases (10%) had excellent result, 8 cases (40%) had good result, 7 cases (35%) had fair results and 3 (15%) cases had poor results. - Satisfaction of patients were assessed by satisfaction score of AAOS,17 cases were satisfied with the results of the prostheses and return to their daily activities and 3 cases were not satisfied with the results.14 cases of patients underwent full union of the tuberosities and 3cases had no union of tuberosities to shaft of the humerus. - Post-operative complications of the study include; one case had superficial infection which was treated by daily dressing and IV antibiotics, two cases had dislocation of the head of the prosthesis and one of them the prepared for revision and the other case missed follow-up and three cases had rupture of rotator cuff repair and two cases of the had dislocation and the third case refuse surgery. |