الفهرس 
Historical reviewOnly 14 pages are availabe for public view
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Abstract
- Between the period of February 2012 and February 2016, a
prospective study of twenty patients with post traumatic
comminuted fracture proximal humerus with or without
dislocation of the humeral head had been admitted to El-
Menoufia University Hospital. .Certain inclusion criteria were
used for inclusion of the patients in this study including criteria
in the patients and criteria related to the fracture type. Exclusion
of revision arthroplasty cases and unfit patients form the study.
All cases included in the study fulfill the inclusion criteria. Full
history and clinical examination were done for all cases of the
study. The age of this group ranges between 52to 75 years, with six males and 14 females. Twelve cases were house wife, 2
were civil servant, 2 retired, one lecturer and one taxi driver.
Twelve cases of the study had chronic medical problems which
are controlled prior to sugery.The study include two cases had
previous trauma to shoulder and they were included in the study
after exclusion of the infection and nerve injury. The cause of
trauma was low energy trauma in 12 cases and high energy
trauma was in 8 cases and one case had associated injury . Right
shoulder was affected in 16 cases while left shoulder was
affected in 4 cases.14 cases were four-part fracture,5 cases were
three part fracture and one case was two part fracture. Time gab
between trauma and operation varies from one week up to
twenty four weeks. Radiological investigations including X-ray
and CT were done for all cases of the study. MRI needed only
in one case. EMG was needed in one case.
- Pre-operative antibiotic protocol was used .General anesthesia
was used for all cases of the study. Beach chair position and
delto-pectoral approach was used in all cases of the study
.Identification of biceps tendons with identification of lesser
and greater tuberosities were done. Proper sizing of the stem
and the head of the prosthesis was done. Repair of the tendons
to the prosthesis and bone were done. Eight cases need blood
transfusion. Repair of rotator cuff tendons by trans-osseous
sutures in 17 cases and directly to the prosthesis fins in 3
cases.Bicepes tenodesis were done in 13 cases. 2 cases had
partial tear of rotator cuff tendons which was discovered during
operation and repair of tendon were done with non-absorbable
sutures. The stem diameter ranged from 7 to 10 mm and the
head diameter ranged from 42 to 46mm.16 cases had prosthesis with central offset and 4 cases had prosthesis with eccentric
offset. The operative time ranged from 1.5 to2.5 hours. There
were no intra-operative complications during surgery.
- -Single post-operative protocol was used in all cases of the
study in terms of antibiotic regimen, hospital stay and
rehabilitation protocol. The follow-up visits were scheduled at 2
weeks, 6 weeks, 3 months, 6 months, 1 year post-operatively.
The cases of the study were assessed clinically in terms of range
of motion, constant score and satisfaction score. Radiological
evaluation was done by follow up X-rays to assess cement
mantle, tuberosities union and tendon repair.
- Post-operative range of motion ranges from 20 degrees to 105
degrees, from 10 degrees to 95 degrees in abduction, from 10
degrees to 40 degrees in extension and from 10 degrees to 40
degrees in adduction. Post –operative results were assessed by constant score. 2 cases (10%) had excellent result, 8 cases
(40%) had good result, 7 cases (35%) had fair results and 3
(15%) cases had poor results.
- Satisfaction of patients were assessed by satisfaction score of
AAOS,17 cases were satisfied with the results of the prostheses
and return to their daily activities and 3 cases were not satisfied
with the results.14 cases of patients underwent full union of the
tuberosities and 3cases had no union of tuberosities to shaft of
the humerus.
- Post-operative complications of the study include; one case had
superficial infection which was treated by daily dressing and IV
antibiotics, two cases had dislocation of the head of the
prosthesis and one of them the prepared for revision and the
other case missed follow-up and three cases had rupture of
rotator cuff repair and two cases of the had dislocation and the
third case refuse surgery.