Получена: 20/04/2023/ Принята: 22/09/2023 / Опубликована online: 30/10/2023
УДК 616-08;616.72-001.6.717.2
DOI 10.53511/PHARMKAZ.2023.84.84.019
ZH. ARGYNBAYEV1, А. DZHUMABEKOV2, Y. NABIYEV3, К.TEZEKBAEV4, B. DOSMAILOV5,S. ALKHOJAYEV7, D. TUSUPOV6, U.M. ABUJAZAR8
1″GSPH» Kazakhstan Medical University, Almaty, Kazakhstan
2″GSPH» Kazakhstan Medical University, Almaty, Kazakhstan
3Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
4Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
5City Clinical Hospital No. 4, Almaty
6City Clinical Hospital No. 4, Almaty
7Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
8Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
OUR EXPERIENCE IN THE TREATMENT OF FRACTURES
OF THE PROXIMAL HUMERUS
Introduction. Improvement of both means of osteosynthesis and methods of restorative treatment of nearand intra-articular fractures of the humerus is an urgent problem of modern traumatology and therefore often
attracts the attention of researchers.
Purpose: to study the long-term results of surgical treatment of patients in whom fractures of the proximal
humerus were fixed with lockable plates.
Materials and methods. The authors presented in the article the outcomes of treatment of 36 patients with
a fracture of the proximal part of the shoulder. The age of the patients varies in the range of 18-75 years, all
of them were operated on in the traumatology department of the city hospital No. 4 in 2019-2021. There were
12 (33.4%) men and 24 (66.6%) women.
Results and conclusions. Excellent and good results of treatment were observed mainly in 2- and 3-fragment
fractures, as well as in those operated on in the early stages. Blocked plates made it possible to obtain positive
results of treatment in 69.5% of cases, and satisfactory results in 16.7% of cases. Unsatisfactory outcomes
were noted in 13.8% of patients, complications after surgery – in 19.4%. Ensuring stable osteosynthesis in multifragment fractures of the proximal humerus is considered a difficult task. Our material and literature data confirm
that the percentage of complications after osteosynthesis of the humerus can increase not only if the operation
technique is not followed, but they are also associated with the presence of osteoporosis, osteonecrosis, and
pathological tissue regeneration.
Keywords: humerus, proximal part of the shoulder, osteosynthesis, lockable plate.
REFERENCES
1 Lazarev, A.A. Osteosynthesis of fractures of the proximal humerus with Y-shaped stressed spokes: diss. … Candidate of Medical Sciences: 14.00.22. A.A.
Lazarev. – Moscow. 2015:105.
2 Launonen AP, Lepola V, Saranko A, Flinkkilä T, Laitinen M, Mattila VM, et al. Epidemiology of proximal humerus fractures.Arch Osteoporos. 2015; 10:209.
3 Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006; 37:691–7.
4 4.Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J. Orthop Trauma.2015; 29:242.
5 Yeldzarov, P.E. Tactics of treatment of patients with the consequences of fractures of the humerus P.E. Elizarov, A.S. Zelenin, S.E. Nikitin. Surgery named
after N.I.Pirogov. 2010; 9:47-57.
6 Court-Brown, C.M. Nonunions of the proximal humerus: their prevalence and functional outcome. C.M.Court-Brown, M.M.McQeen. J. Trauma. 2008;
64(6):1517-1521.
7 Surgical treatment of sequelae of fractures of the humerus. The role of osteotomies. Russo R, Vernaglia L, Giudice G. Chir Organi Mov. 2005; 90(2):159-69.
8 Early rehabilitation of patients with fractures of the proximal humerus. N.D. Batpenov, E.N. Nabiev, R.O. Ishmakov. Scientific and practical journal «Modern
Science. Actual problems of theory and practice». 2017; 12:74-80.
9 Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C, et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop
Traumatol Surg Res. 2012; 98:715–9.
10 Handoll HH, Ollivere BJ, Rollins KE. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2012;12:CD000434.
11 Resch H, Hubner C, Schwaiger R. Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head.Injury. 2001; 32:25–SA32.
12 Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clin Orthop
Relat Res. 2005; (430):176–181.
13 Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, Duda GN. Proximal humeral fractures: how stiff should an implant be? A comparative mechanical
study with new implants in human specimens. Arch Orthop Trauma Surg. 2003;(123):74–81.
14 Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop
Relat Res. 2006; (442):115–120.
15 Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P. Open reduction and internal fixation of proximal humerus fractures using a proximal
humeral locked plate: a prospective multicenter analysis. J. Orthop Trauma. 2009;(23):163–172.
16 Checchia SL, Doneux PS, Miyazaki AN, Fregonese M, Silva LA, Lobo AC. Avaliação do tratamento cirúrgico da fratura em duas partes do colo cirúrgico
do úmero com placa PFS 80°Rev. Bras Ortop. 2004; 39(10):555–567.
17 Gorodilov, V.Z. Internal strained osteosynthesis with fixators with shape memory with non-joined tubular diaphysis. V.Z. Gorodinov. Topical issues of
implantology and osteosynthesis: tez. dokl. nauchn.-practical conf. Novokuznetsk. 2004:9-14.
18 Haidukewych, G. J. Innovations in locking plate technology. J. Am. Acad. Orthop. Surg. 2004; 12:205-212.
19 Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate. A retrospective evaluation of
72 pacients followed for a minimum of 1 year. Acta Orthop Scand. 2004; 75(6):741–745.
20 Shahid R, Mushtaq A, Northover J, Maqsood M. Outcome of proximal humerus fractures treated by PHILOS plate internal fixation. Experience of a district general hospital. Acta Orthop Belg. 2008;74(5):602–608.
21 Fazal MA, Haddad FS. Philos plate fixation for displaced proximal humeral fractures. J. Orthop Surg. 2009;17(1):15–18.
22 Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal
humerus plate. Results of a prospective, multicenter, observational study. J. Bone Joint Surg Am. 2009; 91(6):1320–1328.
23 Owsley KC, Gorczyca JT. Displacement/screw cutout after open reduction and locked plate fixation of proximal humeral fractures. J. Bone Joint Surg Am.
2008; 90(2):233–240.
24 Agudelo J, Schürmann M, Stahel P, Helwig P, Morgan SJ, Zechel W. Analysis of efficacy and failure in proximal humerus fractures treated with locking
plates. J. Orthop Trauma. 2007; (21):676–681.
25 Duralde XA, Leddy LR. The results of ORIF of displaced unstable proximal humeral fractures using a locking plate. J. Shoulder Elbow Surg. 2010;19(4):480–
488.
26 Plecko M, Kraus A. Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Operat Orthop Traumatol. 2005; (17):25–50.
27 Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF. Pitfalls and complications with locking plate for proximal humerus fracture. J. Shoulder Elbow Surg.
2010; (19):489–494.
28 Zorya, V.I. Bone cement osteosynthesis of limb bone fractures in osteoporosis / V.I. Zorya, N.N. Karchebny. Treatment of combined injuries and diseases
of the extremities: tez.conf. M.2003:125-126.
29 Sikilinda, V.D. Evolution of bone osteosynthesis in the treatment of injured patients with osteoporosis. Science and practice. 2004; 5:1-6.
30 Röderer G, Scola A, Schmölz W, Gebhard F, Windolf M, Hofmann-Fliri L. Biomechanical in vitro assessment of screw augmentation in locked plating of
proximal humerus fractures. Injury. 2013; 44: 1327–1332.
31 Kathrein S, Kralinger F, Blauth M, Schmoelz W. Biomechanical comparison of an angular stable plate with augmented and non-augmented screws in a
newly developed shoulder test bench. Clin Biomech. 2013; 28: 273–277.
32 Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J
Orthop Trauma. 2008; 22:195–200.
33 Osterhoff G, Baumgartner D, Favre P, Wanner GA, Gerber H, Simmen HP, CML W. Medial support by fibula bone graft in angular stable plate fixation of
proximal humeral fractures: an in vitro study with synthetic bone. J. Shoulder Elb Surg. 201120: 740–746.
34 Guidelines for internal osteosynthesis. M.E. Muller, M. Allgover, R. Schneider, R. Methodology recommended by the AO group (Switzerland). SpringerVerlag. 1996:750.
35 Mattis, E.R. Examination of the outcomes of intra- and periarticular fractures and their consequences. Intra- and periarticular injuries of the musculoskeletal
system. L., 1983:94-98.
36 Handschin AE, Cardell M, Contaldo C, Trentz O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures.
Injury. 2008; 39(3):306–313.
37 Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011; 42:408–13.
38 Bachelier F, Pizanis A, Schwitalla J, Pohlemann T, Kohn D, Wirbel R, et al. Treatment for displaced proximal humerus fractures: Comparison of interlocking
plate fixation versus minimal invasive techniques. Eur. J. Orthop Surg Traumatol. 2014; 24: 707–14.
39 Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in
elderly patients: A randomized controlled trial. J. Shoulder Elbow Surg. 2011; 20:747–55.
40 Monteiro GC, Ejnisman B, Andreoli CV, Pochini AC, Olympio E. Resultados do tratamento das fraturas do terço proximal do úmero com placas de bloqueio.
Acta Ortop Bras. 2011;19(2):63–69.
41 Badman BL, Mighell M. Fixed-angle locked plating of two-, three-, and four-part proximal humerus fractures. J. Am Acad Orthop Surg. 2008; 16:294–302.
42 Nasyrov, U.I. Surgical treatment of fractures of the proximal humerus. Osteosynthesis of the surgical neck of the shoulder with lavsan / U.I. Nasyrov, M.K.
Kudaikulov, B.D. Isakov // Materials of the VIII Congress of Traumatologists-orthopedists of Russia. 2006:457-458.
43 Kim SH, Lee YH, Chung SW, Shin SH, Jang WY, Gong HS, et al. Outcomes for four-part proximal humerus fractures treated with a locking compression
plate and an autologous iliac bone impaction graft. Injury. 2012; 43: 1724–31.
44 Voigt C, Geisler A, Hepp P, Schulz AP, Lill H. Are polyaxially locked screws advantageous in the plate osteosynthesis of proximal humeral fractures in the
elderly? A prospective randomized clinical observational study. J. Orthop Trauma. 2011; 25:596–602.
45 Zhang L, Zheng J, Wang W, Lin G, Huang Y, Zheng J, et al. The clinical benefit of medial support screws in locking plating of proximal humerus fractures:
A prospective randomized study. Int. Orthop. 2011;35: 1655–61.
46 Ricchetti ET, Warrender WJ, Abboud JA. Use of locking plates in the treatment of proximal humerus fractures. J. Shoulder Elbow Surg. 2010; 19:66–75.
47 Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal
humerus plate. Results of a prospective, multicenter, observational study. J. Bone Joint Surg Am. 2009; 91(6):1320–1328.
48 Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked
plates. J. Orthop Trauma. 2008;22(3):159–164.
49 Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M. Proximal humeral internal locking system (PHILOS) for the treatment
of proximal humeral fractures. Arch Orthop Trauma Surg. 2007;127(3):205–210.
50 Ricchetti ET, DeMola PM, Roman D, Abboud JA. The use of precontoured humeral locking plates in the management of displaced proximal humerus
fracture. J. Am Acad Orthop Surg. 2009; 17:582–90.
51 Egol KA, Sugi MT, Ong CC, Montero N, Davidovitch R, Zuckerman JD, et al. Fracture site augmentation with calcium phosphate cement reduces screw
penetration after open reduction-internal fixation of proximal humeral fractures. J. Shoulder Elbow Surg. 2012; 21:741–8.
52 Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P. Treatment of proximal humerus fractures with locking plates: a systematic review. J. Shoulder
Elbow Surg. 2009;(18):837–844.
53 Zhu Y, Lu Y, Shen J, Zhang J, Jiang C. Locking intramedullary nails and locking plates in the treatment of two-part proximal humeral surgical neck fractures:
A prospective randomized trial with a minimum of three years of followup. J. Bone Joint Surg Am.2011; 93:159–68.
54 Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J. Orthop Trauma. 2004; 18:488.
