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Online ISSN 1827-1707
PAPERS ON SHOULDER
Blonna D., Fantino G., Assom M., Dettoni F., Rossi R., Castoldi F.
Divisione di Ortopedia e Traumatologia Ospedale Mauriziano Umberto I Università degli Studi di Torino, Torino
Aim. Recent epidemiologic analysis has shown that one of the commonest humeral fracture is the AO A2.2 impacted-varus. The purpose of the study is two-fold: 1) compare the results of the conservative management versus K-wires osteosynthesis in patients with A2.2 fractures; 2) analyse the results of the same technique in type A3.2, B and C fractures.
Methods. Over a period of 4 years we prospectively followed 93 patients with proximal humeral fracture. Inclusion criteria were: enough communicative skill to complete a Constant score (CS), compliance to the physiotherapy, absence of previous shoulder disease. The examinations were performed at 6, 12 and 24 months. All the patients with A2.2 fracture, not suitable for operation due to general medical problems or that didn’t consent to the operation were included in the nonoperative group. The treated-group underwent fixation using k-wires after a closed reduction or after an open reduction if the fracture couldn’t be reduced percutaneously.
Results. Ninety-three patient were initially included in the study. Forty-nine patients in the treated-group (27-A2.2; 8-A3.2; 7 B; 7 C) and 28 in the control-group completed the follow-up. During all the follow-up the A2.2 surgical-group has a CS statistically better than the A2.2-control group with a low incidence of complications. In the A3.2 and B2.2 group the complication rate was high.
Conclusions. There is evidence that k-wires technique for A2.2 fractures confers benefit even in old patients. For type B2.2 and A3.2 we recommended open reduction and plate fixation.