髄内釘による高齢者上腕骨近位端骨折の問題点の検討

概要

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We treated 17 elderly patients with proximal humeral fractures who were more than 70 years old using intramedullary nail, including 4 males and 13 females with an average age of 84 years old (ranging from 71 to 96 years old). According to AO classification, there were 8 cases of A2, 2 cases of A3, 4 cases of B1, and 3 cases of B2. The surgery in all cases was performed under general anaesthesia. The reduction was checked fluoroscopically. Post-operatively the arm was supported in a sling. Pendular movements were started from the first post-operative day. The functional and radiological outcomes were reviewed. 17 patients were assessed with regard to pain and shoulder flexion. Callus formation and cortical continuity was observed on radiographs for evidence of radiological union. In our study all the fractures united clinically and radiologically except in two patients. There was one case of nonunion. An open reduction and internal fixation with bone graft was undertaken five months after intramedullary nail fixation. Cut out of the nail from the humeral head was found in one case and a hemiarthroplasty was undertaken three weeks after intramedullary nail fixation. We stressed the importance of anatomical reduction of the fracture and correct surgical technique. Depending on the fracture type, it is important that the greater tuberosity with the rotator cuff tendons is sutured to the nail with nonabsorbable thread.