上腕骨近位端骨折にPHILOSを用い遷延治癒を呈した3例の検討

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The aim of this study is to clarify the complications of PHILOS for proximal humeral fracture. [Case 1] A 58-year-old woman fell, and was diagnosed as having 3-part fracture by Neer classification. Open reduction and internal fixation was done with PHILOS. There were 7 locking screws in the proximal side and 3 screws in the distal side. The stability was rigid. After four months, we diagnosed delayed union, so ultrasound stimulation was carried out. Finally bone union was obtained, but partial osteonecrosis of the humeral head existed. JOA score was 78 points. [Case 2] A 58-year-old woman was diagnosed as having 4-part fracture. Operation was done using PHILOS, 9 locking screws were in the proximal side and 3 screws were in the distal side. The stability was rigid. After four months, we diagnosed delayed union, so ultrasound stimulation was carried out. JOA score was 88 points. [Case 3] A 78-year-old woman was diagnosed as having 3-part fracture. Operation was done using PHILOS, 7 locking screws were in the proximal side and 3 screws were in the distal side. The stability was rigid. We diagnosed delayed union at five months postoperatively.Too rigid fixation using PHILOS sometimes causes delayed union of proximal humeral fracture. We need more study about appropriate fixation using PHILOS.
2010-08-04