Relevance. Shoulder prosthetics is the method of choice in the treatment of patients with traumatic injuries that significantly impair joint function and are accompanied by prolonged pain.
Objective: to investigate the main causes of injuries of the shoulder joint that led to its prosthetics.
Materials and Methods. The clinical group consisted of 162 patients who underwent shoulder prosthetics in the Department of Microsurgery and Reconstructive Surgery of the Upper Limb of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”. There were 44.4% male and 55.5% female patients. The average age of male patients was 62±11.4 years; the average age of female patients was 66±10.1 years. The average period of seeking specialized medical care after an acute injury was 24±10.9 days and 50.6±81.1 months in patients with post-traumatic consequences. In most cases, patients underwent unipolar prosthetics of the shoulder joint (126 patients, 78.7%); 27 patients (15.6%) underwent reversible prosthetics and 9 (5.6%) – total prosthetics, respectively.
Results. In most cases, shoulder prosthetics were performed in patients with acute (up to 3 weeks from the date of injury) and old fractures and fractures of the proximal epimetaphysis of the humerus – 35 (21.6%) and 48 (29.6%) patients, respectively. The number of patients with posttraumatic aseptic necrosis of the humeral head was 49 (30.2%) (p<0.005), which indicates a high frequency of complications after osteosynthesis etc. The number of patients with massive traumatic injuries of the tendons of the rotator cuff who needed shoulder prosthetics was 18 (11.1%) and with false joints – 12 (7.4%). Unipolar prosthesis systems predominated in the general structure of the prosthesis type (126 patients, 78.7%), since reversible and total prosthesis in Ukraine were registered not so long ago.
Conclusions. The analysis of our observations showed that the causes of shoulder prosthetics are severe injuries that occur with high-energy injuries (101 patients, 62.3%) and post-traumatic aseptic necrosis (49 patients, 30.2%). Acute and old fractures and fractures of the proximal metaepiphysis of the humerus are one of the most common injuries according to the analysis (35 patients, 21.6% and 48 patients, 29.6%), and their number and complexity continues to increase with age. Understanding the etiological factors that led to shoulder endoprosthetics makes it possible to predict long-term functional results and work to reduce the number of such patients.
Lübbeke A, Rees JL, Barea C, Combescure C, Carr AJ, Silman AJ. International variation in shoulder arthroplasty. Acta Orthop. 2017; 88 (6): 592-599. DOI: 10.1080 / 17453674.2017.1368884.
Stechel A, Fuhrmann U, Irlenbusch L, Rott O, Irlenbusch U. Reversed shoulder arthroplasty in cuff tear arthritis, fracture sequelae, and revision arthroplasty. Acta Orthop. 2010; 81 (3): 367-372. DOI: 10.3109 / 17453674.2010.487242.
Sakai T, Sugano N, Nishii T, Hananouchi T, Yoshikawa H. Extent of osteonecrosis on MRI predicts humeral head collapse. Clin Orthop Relat Res. 2008; 466 (5): 1074-1080. DOI: 10.1007 / s11999-008-0179-6
Schlegel TF, Hawkins RJ. Displaced Proximal Humeral Fractures: Evaluation and Treatment. J Am Acad Orthop Surg. 1994 Jan; 2 (1): 54-78. DOI: 10.5435 / 00124635-199401000-00007.
Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970; 52 (6): 1090-103.
Archer LA, Furey A. Rate of avascular necrosis and time to surgery in proximal humerus fractures. Musculoskelet Surg. 2016 Dec; 100 (3): 213-216. DOI: 10.1007 / s12306-016-0425-0.
Jost B, Spross C, Grehn H, Gerber C. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg. 2013; 22 (4): 542-549. DOI: 10.1016 / j.jse.2012.06.008.
Gerber C, Hersche O, Berberat C. The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg. 1998; 7 (6): 586-590. DOI: 10.1016 / s1058-2746 (98) 90005-2
Gerber C, Hersche O, Berberat C. The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg. 1998; 7 (6): 586-590. DOI: 10.1016 / s1058-2746 (98) 90005-2.
Drake GN, O’Connor DP, Edwards TB. Indications for reverse total shoulder arthroplasty in rotator cuff disease. Clin Orthop Relat Res. 2010; 468 (6): 1526-1533. DOI: 10.1007 / s11999-009-1188-9.
Burkhart SS, Lo IK. Arthroscopic rotator cuff repair. J Am Acad Orthop Surg. 2006; 14 (6): 333-346. DOI: 10.5435 / 00124635-200606000-00003.
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