Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
-
Fractures of the proximal humerus actually represent 5% of all fractures and 45% of all humeral fractures with the highest incidence in women over 60 years of age. The outcomes of the greatest concern at these patients (pain, function of the shoulder and activities of daily living) get worse with age, osteoporosis, grading of fracture type and of initial fracture displacement. According to the literature (Evidence Based Medicine--EBM level II-III) operative treatment of displaced fractures reduces pain and need for assistance in activities of daily living, but open reduction with internal fixation by conventional screws and plates was connected with implant loosening, infection and avascular necrosis, whereas closed reduction with different methods of miniinvasive percutaneous stabilisation is threatened by primary malreduction. ⋯ In spite of low follow-up rate we conclude, that the method of closed reduction and intramedullary fixation of two- and three-part fractures of proximal humerus after Zifko offers above-average final results with acceptable rate of complications, mostly not severe ones. The essential pre-condition of good result is proper reduction--closed of percutaneous one. On the contrary, suboptimal results correlate with primary and secondary malreductions. The incidence of latter increases in intraarticular fracture types with small fragment of head and thus with insuficient implant retention. To evaluate the merit of the method in relation to angle-stable extra-/or intramedullary implants, the prospective trials are needed.