上腕骨近位端・近位骨幹端骨折に対する transmedullary support screwの応用

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In the wake of recent improvement of intramedullary nails, the application of intramedullary nailing to a fracture of the humerus has been expanding as well as to the lower extremities. However, conventional intramedullary nailing has problems in reduction and fixation in some fracture types. This paper reports on the method and clinical results of our treatment using intramedullary nailing and transmedullary support screws combined together. During the period between 2003 and 2006, we had 12 cases (males5, females7) of intramedullary nailing combined with transmedullary support screw use for the fracture of the humerus, of which 6 cases were fresh and 6 were non-union after conservative treatment at former clinics. All the cases had the fracture lines running spirally or obliquely. The average age of the patients was 60 (42-69 years old), the average follow-up period was 22 months (3-40 months). We studied these 12 cases about fracture types and treatment methods and evaluated the results with x-rays and from the ROMs of the shoulder and elbow joints. As for fracture types, there were three 11-A3.1, two 11-A3.2, five 12-A1.1, two 12-A2.1 cases by OTA classification. As for the insertion point of the deltoid, seven cases were at the proximal fragment, and five at the distal fragment. We used transmedullary support screws in the proximal fragment in eight cases, and in the distal fragment in four cases. Among six non-union cases, we transplanted the iliac bone in only one case. We observed bone-union in all the cases. The ROM was the same as the non-affected side in eight cases, however we observed limitation of external rotation and elevation of the shoulder joint in four cases. In 1999, Krrettek reported on a method using screws around intramedullary nails by the name of Pollerscrews. This method has been mainly applied to fractures of the tibia and femur, however it is an effective method also for spiral or oblique fractures in proximal metaphysis as long as you keep a close watch on the insertion of the humerus and the type of fracture.
日本肩関節学会の論文

上腕骨近位端・近位骨幹端骨折に対する transmedullary support screwの応用

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