Tratamiento quirúrgico de las fracturas periprotésicas de húmero y algoritmo de actuación / Surgical treatment of periprosthetic humerus fractures and algorithm

INTRODUCCIÓN: Las fracturas periprotésicas de húmero son infrecuentes y su manejo, difícil. La bibliografía es limitada y no existe consenso sobre su tratamiento. MATERIAL Y MÉTODO: Hemos realizado un estudio observacional retrospectivo de 10pacientes con fractura periprotésica de húmero con un seguimiento de 25,1 meses (6-87). Valoramos los resultados clínicos, radiológicos y funcionales, como las complicaciones. Utilizamos el cuestionario Quick-DASH y UCLA Shoulder Score (UCLASS). Realizamos una búsqueda sistemática para comparar la serie presentada y los protocolos de tratamiento publicados. RESULTADOS: Diez pacientes con una media de edad de 69,4 años (37-91) fueron intervenidos quirúrgicamente: 8 mediante reducción abierta y fijación interna (RAFI), en otro se realizó un recambio protésico colocando una nueva prótesis con un vástago más largo, y en el último se retiró la prótesis y se realizó una osteosíntesis con un clavo endomedular. Nueve de 10 pacientes consolidaron en un tiempo de 6,2 meses (rango 5-12); el restante sufrió una nueva fractura 5 meses después, siendo reintervenido, realizándole una nueva osteosíntesis, con aporte de aloinjerto óseo, que consolidó a los 8meses de la última fractura. En relación con la situación previa a la fractura, los pacientes tenían como promedio un descenso notable de la función, que era de 10,66 puntos en el test de UCLASS y un ascenso de 27,3 puntos en el cuestionario Quick-DASH. CONCLUSIONES: Nuestra serie tiene similitudes con las publicadas en relación con los aspectos demográficos, las complicaciones y el tiempo de consolidación. Sin embargo, en otros aspectos, como el dolor y los resultados funcionales, encontramos gran variabilidad

INTRODUCTION: Periprosthetic humerus fractures are infrequent and sometimes difficult to treat. There is limited literature and no consensus on the handling of these fractures. The objective of this study was to compare our results with those published in the literature, in order to improve our care and propose a management algorithm. MATERIAL AND METHOD: Observational study of 10 cases of periprosthetic humerus fractures with a mean follow-up of the patients of 23 months. An analysis of sociodemographic, radiological and surgical variables was performed. They were reviewed clinically and by telephone using the UCLA Shoulder Score and Quick-DASH scales. A systematic search was made in Pubmed for periprosthetic humerus fractures, for a literature review with which to compare our series. RESULTS: We analysed 10 patients with an average age of 69.4 years (37-91). Of the patients, 90% underwent surgery through open reduction and internal fixation. Nine of the ten patients consolidated in a mean time of 6.2months (range 5-12), the remaining suffered a new fracture 5 months after the intervention, who were reoperated and a new osteosynthesis performed with bone allograft. In the UCLA scale there was a decrease of 10.66 points, and an increase of 27.3 points in the Quick-DASH, at the end of the follow-up. CONCLUSIONS: In our series of cases we found similarities in the literature, in relation to demographic aspects and obtaining good radiographic results, which do not correspond to the functional outcome of patients

Surgical treatment of periprosthetic humerus fractures and algorithm. / Tratamiento quirúrgico de las fracturas periprotésicas de húmero y algoritmo de actuación.

INTRODUCTION: Periprosthetic humerus fractures are infrequent and sometimes difficult to treat. There is limited literature and no consensus on the handling of these fractures. The objective of this study was to compare our results with those published in the literature, in order to improve our care and propose a management algorithm. MATERIAL AND METHOD: Observational study of 10cases of periprosthetic humerus fractures with a mean follow-up of the patients of 23months. An analysis of sociodemographic, radiological and surgical variables was performed. They were reviewed clinically and by telephone using the UCLA Shoulder Score and Quick-DASH scales. A systematic search was made in Pubmed for periprosthetic humerus fractures, for a literature review with which to compare our series. RESULTS: We analysed 10patients with an average age of 69.4years (37-91). Of the patients, 90% underwent surgery through open reduction and internal fixation. Nine of the ten patients consolidated in a mean time of 6.2months (range 5-12), the remaining suffered a new fracture 5months after the intervention, who were reoperated and a new osteosynthesis performed with bone allograft. In the UCLA scale there was a decrease of 10.66points, and an increase of 27.3points in the Quick-DASH, at the end of the follow-up. CONCLUSIONS: In our series of cases we found similarities in the literature, in relation to demographic aspects and obtaining good radiographic results, which do not correspond to the functional outcome of patients.