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Master thesis

Ostéosynthèse des fractures à 3 et 4 fragments de l'extrémité proximale de l'humérus par plaque à vis verrouillées ou enclouage antérograde. Etude comparative rétrospective à propos de 67 cas

Abstract : Introduction : There is no consensus as to treatment of proximal humeral fracture. The present retrospective observational study compare functional and radiological results and complications in osteosynthesis using locking plates versus antegradenails in the treatment of non-osteoporotic 3 and 4 part fracture on the Neer classification at a minimum 1 years'follow up.Material and methods : 67 patients underwent osteosynthesis: 35 by locking plate (1 lost to follow-up, 1 deceased) and 32 by intramedullary nailing (2 lost to follow-up) between January 1st, 2004 and December 31st, 2010. The study thus included33 plates (21 3-part and 12 4-part fractures) and 30 nails (21 3-part, 9 4-part fractures). End-of-follow-up functional assessment used Oxford, Constant, relative Constant, QuickDASH scores and percentage incapacity. Radiologic follow-upused immediate postoperative, 6 week, 3 months and 1 year AP and Lamy lateral views. All complications were recorded prospectively. Results: For the plate and nail groups respectively, mean Oxford, Constant, relative Constant, QuickDASH scores and percentage incapacity were: 23.8 vs. 23.3, 59.7 vs. 60 6, 73.5 vs 79.3, 20.9 vs 21.0, 22.6 vs 22.6. Multivariate analysis found no significant difference for functional scores and reduction quality: final frontal reduction defect, 30.3 vs. 36.7%; lateral defect, 3.2 vs. 10.0%; greater tuberosity, 9.1 vs. 16.7%. Four-part fracture (p<0.05), frontal reduction defect at follow-up (p<0.05) or greater tuberosity defect (p>0.05) had negative impacts on functional scores. The complications rates were in line with the literature and did not differ between techniques (p=0.1901) except for 3 infections in the plate group. Discussion-Conclusion : Osteosynthesis is the treatment of choice for 3 and 4 part fractures in young nonosteoporotic patients. Although no difference was found in the present study between locking plate and intramedullary nailing, the former seems less well adapted, at the cost of a more aggressive technique
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Guillaume Boudard. Ostéosynthèse des fractures à 3 et 4 fragments de l'extrémité proximale de l'humérus par plaque à vis verrouillées ou enclouage antérograde. Etude comparative rétrospective à propos de 67 cas. Sciences du Vivant [q-bio]. 2013. ⟨hal-01732069⟩

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