RESUMO
ABSTRACT OBJECTIVE: This study aimed to assess the outcomes of patients with humeral head fractures treated by reduction and osteosynthesis. METHOD: A total of 53 shoulders (52 patients) with humeral head fractures were operated between October 1996 and December 2009. Patients previously treated with primary arthroplasty and/or those who had less than two years follow-up were excluded. A total of 34 shoulders of 34 patients were therefore reassessed. In the sample studied, 23 patients were male and mean age was 47 years. Cases were assessed based on the UCLA score. RESULTS: Mean post-operative follow-up was 50 months. Twelve patients evolved with excellent outcome, seven good, five regular, and ten with poor outcome (55.8% satisfactory and 44.2% unsatisfactory outcomes). Mean UCLA score was 26 points. Mean post-operative range of motion measurements was 117° elevation, 36° LR and L1 MR. At the immediate post-operative radiography, anatomic reduction was evident in 17 patients (50%). Necrosis was detected in 18 patients, six Grade II and 12 Grade III cases. Female gender and anatomically reduced fractures were statistically better at UCLA scale (p = 0.01 and p = 0.0001 respectively). CONCLUSIONS: Female patients had a higher mean UCLA score than male patients (p = 0.01). Anatomically reduced fractures had higher UCLA scores (p = 0.0001) and lower necrosis rate (p = 0.0001). Reconstruction of humeral head fractures had a satisfactory outcome in 55.8% of cases and should be indicated in young and active patients.
RESUMO OBJETIVO: Avaliar os resultados dos pacientes com fraturas epifisárias tratados com redução e osteossíntese. MÉTODO: Entre outubro de 1996 e dezembro de 2009 foram operados 53 ombros (52 pacientes) com fraturas epifisárias. Foram excluídos os pacientes tratados com artroplastia primária e/ou que tinham seguimento inferior a dois anos. Foram reavaliados 34 ombros de 34 pacientes, 23 do sexo masculino, com média de 47 anos. A avaliação foi feita com a escala da UCLA. RESULTADOS: O tempo de seguimento pós-operatório médio foi de 50 meses. Doze pacientes evoluíram com resultados excelentes, sete bons, cinco regulares e dez maus (55,8% de resultados satisfatórios e 44,2% de insatisfatórios). O escore UCLA teve média de 26 pontos. As médias de mobilidade pós-operatória foram de 117° de elevação, 36° de RL e L1 de RM. No RX pós-operatório imediato, verificamos a redução anatômica em 17 pacientes (50%). A necrose foi constatada em 18 pacientes, seis grau II e 12 grau III. Sexo feminino e fraturas reduzidas anatomicamente foram estatisticamente melhores na escala da UCLA (p = 0,01 e p = 0,0001 respectivamente). CONCLUSÕES: O sexo feminino teve um valor médio do UCLA superior ao sexo masculino (p = 0,01). As fraturas reduzidas anatomicamente obtiveram UCLA superior (p = 0,0001) e um menor índice de necrose (p = 0,0001). A reconstrução das fraturas epifisárias levou a resultados satisfatórios em 55,8%, deve ser indicada para pacientes jovens e ativos.