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Master thesis

Complications des enclouages antérogrades de l'humérus proximal: A propos de 34 cas

Abstract : Purpose. The retrospective study of intra-medullary nailing complications in two institutions: causes, consequence, and treatment. Patients and methods. 34 patients had been referred for complications of locked intra-medullary nailing. According to Neer, initial lesions consisted in 8 part II, 5 part III and 21 part IV fractures among them 9 were fractures dislocations. Results. Complications consisted in 17 hardware protusions, 14 malunions, 10 humeral osteonecrosis, 7 humeral neck nonunions, 4 cuff tears. Complications were considered as du to a wrong indication in 11 cases (32%), to a technical mistake in 8 (23%), to the hardware in 9 (27%) and to the fracture itself in 6 (18%). the reoperation consisted in shoulder prothesis in 18 cases (53%) (5 hemi, 4 total, 9 reversed), 12 arhtrolysis (35%) with removal of the hardware and cuff repair, 4 secondary osteosynthesis (12%). Reoperation occured at an average delay of 16,5 months after the initial fracture ; prior to it. Constant Score (C.S.) was 27,6. At an average follow-up of 19 months, the C.S. was 44 (47 for shoulder prothesis, 43 for arthrolysis, 45 for secondary osteosynthesis). Conclusion. Intra-medullary complications are rare, according to the number of fractures and devices used ; most of them are due to a wrong indication (fracture-dislocations). The operative technique is difficult ; the hardware is sometimes aggressive ; humeral neck nonunion, and humeral head osteonecrosis remain at a concerning level. Results of secondary surgical management are poor ; when a shoulder prothesis must de used, its outcome do not reach the level of the one performed in acute conditions.
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Submitted on : Wednesday, March 14, 2018 - 2:40:08 PM
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Richard Philippe. Complications des enclouages antérogrades de l'humérus proximal: A propos de 34 cas. Sciences du Vivant [q-bio]. 2009. ⟨hal-01732021⟩



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