2015, Número 2
Tratamiento quirúrgico de pacientes con fractura diafisaria del húmero
Álvarez LA, García LY
Idioma: Español
Referencias bibliográficas: 50
Paginas: 179-188
Archivo PDF: 574.15 Kb.
RESUMEN
Fundamento: las fracturas de la diáfisis humeral son por lo general tratadas de forma conservadora, pero existe un pequeño porcentaje de pacientes que necesitan de tratamiento quirúrgico basado en indicaciones muy específicas.
Ojetivo: profundizar en los elementos necesarios para el tratamiento quirúrgico de pacientes con fractura de diáfisis humeral.
Método: se realizó una revisión bibliográfica de un total de 400 artículos publicados en Pubmed, Hinari y Medline mediante el localizador de información Endnote, de ellos se utilizaron 50 citas seleccionadas para realizar la revisión, 47 de ellas de los últimos cinco años donde se incluyeron tres libros.
Desarrollo: se discuten los aspectos relacionados con el diagnóstico clínico e imaginológico. Se abordan las indicaciones quirúrgicas según los criterios del McKee MD basados en propias de la fractura, traumas asociados y propios del enfermo. En relación a los métodos de osteosíntesis se plasman sus indicaciones en cada caso, así como sus ventajas y desventajas. En relación a las complicaciones se describen las más importantes y el accionar médico, se propone un algoritmo para pacientes con lesión del nervio radial.
Conclusiones: el tratamiento quirúrgico de pacientes con fracturas de la diáfisis humeral está basado en indicaciones quirúrgicas muy específicas. El método de osteosíntesis a emplear depende de las ventajas de cada uno y de las condiciones del paciente y el cirujano. Los resultados por lo general son favorables con un mínimo de complicaciones.
REFERENCIAS (EN ESTE ARTÍCULO)
1- Tyllianakis M, Tsoumpos P, Anagnostou K, Konstantopoulou A, Panagopoulos A. Intramedul-lary nailing of humeral diaphyseal fractures. Is dis-tal locking really necessary? Int J Shoulder Surg. 2013 Apr;7(2):65-9.
2- Bercik MJ, Tjoumakaris FP, Pepe M, Tucker B, Axelrad A, Ong A, Austin L. Humerus fractures at a regional trauma center: an epidemiologic study. Orthopedics. 2013 Jul;36(7):e891-7.
3- Hollister AM, Saulsbery C, Odom JL, Anissian L, Garon MT, Jordan J. New technique for humerus shaft fracture retrograde intramedullary nailing. Tech Hand Up Extrem Surg. 2011 Sep;15(3):138-43.
4- Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive Classification of Fractures. New York: Springer Verlag; 1990.
5- McKee MD, Larsson S. Humeral shaft frac-tures. In: Bucholz RW, Heckman JD, Court Brown CM, Tornetta P. Rockwood and Green′s Fractures. 7 th ed. Philadelphia: Lippincott William & Wilkins; 2010. p. 1000-38.
6- Boschi V, Pogorelic Z, Gulan G, Vilovic K, Stalekar H, Bilan K, et al. Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study. Can J Surg. 2013 Feb;56(1):27-34.
7- Lee HJ, Oh CW, Oh JK, Apivatthakakul T, Kim JW, Yoon JP, et al. Minimally invasive plate osteo-synthesis for humeral shaft fracture: a reproducible technique with the assistance of an external fix-ator. Arch Orthop Trauma Surg. 2013 May;133(5):649-57.
8- Stedtfeld HW, Biber R. Proximal third hu-meral shaft fractures - a fracture entity not fully characterized by conventional AO classification. Injury. 2014 Jan;45 Suppl 1:S54-9.
9- Wang X, Chen Z, Shao Y, Ma Y, Fu D, Xia Q. A meta-analysis of plate fixation versus intrame-dullary nailing for humeral shaft fractures. J Orthop Sci. 2013 May;18(3):388-97.
10- Gallucci G, Boretto J, Vujovich A, Alfie V, Donndorff A, De Carli P. Posterior minimally inva-sive plate osteosynthesis for humeral shaft frac-tures. Tech Hand Up Extrem Surg. 2014 Mar;18(1):25-30.
11- Idoine JD 3rd, French BG, Opalek JM, DeMott L. Plating of acute humeral diaphyseal fractures through an anterior approach in multiple trauma patients. J Orthop Trauma. 2012 Jan;26(1):9-18.
12- Cadet ER, Yin B, Schulz B, Ahmad CS, Rosen-wasser MP. Proximal humerus and humeral shaft nonunions. J Am Acad Orthop Surg. 2013 Sep;21(9):538-47.
13- Huang YG, Chang SM. Double crush syn-drome due to plating of humeral shaft fracture. In-dian J Orthop. 2014 Mar;48(2):223-5.
14- Perez E. Fractures of the shoulder, arm, and forearm. En: Canale ST, Beaty JH, editores. Campbell′s Operative Orthopedics. 12 th ed. Philadelph-ia: Elsevier Mosby. 2013. p. 2829-2906.
15- Kapil Mani KC, Gopal Sagar DC, Rijal L, Go-vinda KC, Shrestha BL. Study on outcome of frac-ture shaft of the humerus treated non-operatively with a functional brace. Eur J Orthop Surg Trau-matol. 2013 Apr;23(3):323-8.
16- Mahabier KC, Vogels LM, Punt BJ, Roukema GR, Patka P, Van Lieshout EM. Humeral shaft frac-tures: retrospective results of non-operative and operative treatment of 186 patients. Injury. 2013 Apr;44(4):427-30.
17- Pedrazzini A, Pedrazzoni M, De Filippo M, Nicoletto G, Govoni R, Ceccarelli F. Humeral frac-tures by arm wrestling in adult: a biomechanical study. Acta Biomed. 2012 Aug;83(2):122-6.
18- Sarmiento A. Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. Orthopedics. 2011 Mar;34(3):159.
19- Baltov A, Mihail R, Dian E. Complications af-ter interlocking intramedullary nailing of humeral shaft fractures. Injury. 2014 Jan;45 Suppl 1:S9-S15.
20- Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. J Bone Joint Surg Br. 1998 Mar;80(12):249-253.
21- Singh AK, Arun GR, Narsaria N, Srivastava A. Treatment of non-union of humerus diaphyseal fractures: a prospective study comparing inter-locking nail and locking compression plate. Arch Orthop Trauma Surg. 2014 Jul;134(7):947-53.
22- Spiguel AR, Steffner RJ. Humeral shaft frac-tures. Curr Rev Musculoskelet Med. 2012 Sep;5(3):177-83.
23- Ouyang H, Xiong J, Xiang P, Cui Z, Chen L, Yu B. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an up-dated meta-analysis. J Shoulder Elbow Surg. 2013 Mar;22(3):387-95.
24- Singh AK, Narsaria N, Seth RR, Garg S. Plate osteosynthesis of fractures of the shaft of the hu-merus: comparison of limited contact dynamic compression plates and locking compression plates. J Orthop Traumatol. 2014 Jun;15(2):117-22.
25- Yi JW, Oh JK, Han SB, Shin SJ, Oh CW, Yoon YC. Healing process after rigid plate fixation of hu-meral shaft fractures revisited. Arch Orthop Trau-ma Surg. 2013 Jun;133(6):811-7.
26- Maresca A, Pascarella R, Bettuzzi C, Amen-dola L, Politano R, Fantasia R, et al. Multifocal hu-meral fractures. Injury. 2014 Feb;45(2):444-7.
27- Steffner RJ, Lee MA. Emerging concepts in upper extremity trauma: humeral shaft fractures. Orthop Clin North Am. 2013 Jan;44(1):21-33.
28- Ristic V, Maljanovic M, Arsic M, Matijevic R, Milankov M. Comparison of the results of treat-ment of humeral shaft fractures by different meth-ods. Med Pregl. 2011 Sep-Oct;64(9-10):490-6.
29- Heineman DJ, Bhandari M, Poolman RW. Plate fixation or intramedullary fixation of humeral shaft fractures-an update. Acta Orthop. 2012 Jun;83(3):317-8.
30- Lee TJ, Kwon DG, Na SI, Cha SD. Modified combined approach for distal humerus shaft frac-ture: anterolateral and lateral bimodal approach. Clin Orthop Surg. 2013 Sep;5(3):209-15.
31- Broadbent MR, Will E, McQueen MM. Predic-tion of outcome after humeral diaphyseal fracture. Injury. 2010 Jun;41(6):572-7.
32- Dai J, Chai Y, Wang C, Wen G. Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures: a meta-analysis of RCTs and nonrandomized studies. J Orthop Sci. 2014 Mar;19(2):282-91.
33- Venouziou AI, Dailiana ZH, Varitimidis SE, Hantes ME, Gougoulias NE, Malizos KN. Radial nerve palsy associated with humeral shaft frac-ture. Is the energy of trauma a prognostic factor? Injury. 2011 Nov;42(11):1289-93.
34- Pagonis T, Ditsios K, Christodoulou A, Petsatodis G. Outcome of surgical treatment for complicated humeral shaft fractures in elderly adults with osteoporosis. J Am Geriatr Soc. 2012 Apr;60(4):795-6.
35- Garnavos C. Diaphyseal humeral fractures and intramedullary nailing: Can we improve out-comes? Indian J Orthop. 2011 May;45(3):208-15.
36- Shen L, Qin H, An Z, Zeng B, Yang F. Inter-nal fixation of humeral shaft fractures using mini-mally invasive plating: comparative study of two implants. Eur J Orthop Surg Traumatol. 2013 Jul;23(5):527-34.
37- Zhou ZB, Gao YS, Tang MJ, Sun YQ, Zhang CQ. Minimally invasive percutaneous osteosynthe-sis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach. Int Orthop. 2012 Nov;36(11):2341-5.
38- Huri G, Biçer ÖS, Öztürk H, Deveci MA, Tan I. Functional outcomes of minimal invasive percu-taneous plate osteosynthesis (MIPPO) in humerus shaft fractures: a clinical study. Acta Orthop Trau-matol Turc. 2014;48(4):406-12.
39- Iacobellis C, Agrò T, Aldegheri R. Locked an-tegrade intramedullary nailing of humeral shaft fractures. Musculoskelet Surg. 2012 Aug;96(2):67-73.
40- Verdano MA, Pellegrini A, Schiavi P, Somenzi L, Concari G, Ceccarelli F Humeral shaft fractures treated with antegrade intramedullary nailing: what are the consequences for the rotator cuff? Int Orthop. 2013 Oct;37(10):2001-7.
41- Kiran M, Jee R. Ilizarov's method for treat-ment of nonunion of diaphyseal fractures of the humerus. Indian J Orthop. 2010 Oct;44(4):444-7.
42- Li Y, Wang C, Wang M, Huang L, Huang Q. Postoperative malrotation of humeral shaft frac-ture after plating compared with intramedullary nailing. J Shoulder Elbow Surg. 2011 Sep;20(6):947-54.
43- Rohilla R, Singla R, Magu NK, Singh R, Devgun A, Mukhopadhyay R, et al. Combined radi-al and median nerve injury in diaphyseal fracture of humerus: a case report. Chin J Traumatol. 2013 Dec;16(6):365-7.
44- Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ. Management of humeral shaft fractures. J Am Acad Orthop Surg. 2012 Jul;20(7):423-33.
45- Liu GY, Zhang CY, Wu HW. Comparison of initial nonoperative and operative management of radial nerve palsy associated with acute humeral shaft fractures. Orthopedics. 2012 Aug;35(8):702-8.
46- Rosenbaum A, Uhl R. Nonunion of humeral shaft fractures following flexible nailing fixation. Orthopedics. 2012 Jun;35(6):512-5.
47- Liu Y, Li H. Treatment of non-union of hu-merus diaphyseal fractures. Arch Orthop Trauma Surg. 2014 Oct;134(10):1491.
48- Tsourvakas S, Alexandropoulos C, Papachris-tos I, Tsakoumis G, Ameridis N. Treatment of hu-meral shaft fractures with antegrade intramedul-lary locking nail. Musculoskelet Surg. 2011 Dec;95(3):193-8.
49- Constant CR, Murley AHG. A clinical method of funtional assessment of the shoulder. Clin Or-thop. 1987 Jan;214:160-4.
50- Denies E, Nijs S, Sermon A, Broos P. Opera-tive treatment of humeral shaft fractures. Comparison of plating and intramedullary nailing. Acta Orthop Belg. 2010 Dec;76(6):735-42.