Liječenje prijeloma distalnog humerusa

master's thesis

• Title (english): Distal humerus fracture treatment
• Author: Janja Konjevod
• Mentor: Mario Starešinić (mentor)
• Committee member: Božidar Šebečić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Mario Starešinić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Orthopedics

Abstract

Lakat je trohoginglimoidni zglob koji je s biomehaničkog stajališta jedan od
najkompleksnijih u ljudskom tijelu. Incidencija prijeloma distalnog humerusa izražena
je najviše u dvije dobne skupine, u onoj od dvanaeste do devetnaeste godine i onoj
iznad osamdesete godine života.
Prijelome distalnog humerusa u mlađoj životnoj dobi najčešće uzrokuju ozljede
visoke energije, kao što su prometne nesreće, dok je u starijih ljudi, koji su posebno
skloni prijelomima zbog osteoporoze, pad najčešći uzrok prijeloma. Prema AO
klasifikaciji prijeloma distalnog humerusa, prijelomi tipa A su najčešći, iza njih slijede
prijelomi tipa B, dok su prijelomi tipa C najrjeđe zastupljena skupina.
Prijelome distalnog humerusa može se liječiti operativno i neoperativno.
Neoperativno liječenje rijetko se preporuča mlađim pacijentima. Najčešće se koristi
kad pacijenti imaju visok rizik razvoja komplikacija od operacije. Također se može
koristiti za liječenje prijeloma bez pomaka. Tehnike neoperativnog liječenja uključuju
više metoda, kao što su sadrena udlaga do iznad lakta, ortoze za lakat, trakcija
olekranona i takozvana metoda „vreće kostiju“.
Operativno liječenje je najčešće izbor za liječenje prijeloma distalnog humerusa.
Prijelomi s ozljedama krvnih žila ili živaca indikacija su za hitnu operaciju. Važno je
uzeti preciznu anamnezu kako bi se saznalo što više o mehanizmu ozljede. Vrsta
prijeloma određuje se po rentgenskoj slici.
Otvorena repozicija i unutarnja fiksacija uz korištenje pločica su metoda izbora kako
bi se omogućilo što ranije pokretanje zgloba. Danas postoje brojni alati koji se koriste
u liječenju prijeloma distalnog humerusa, kao što su kortikalni i intramedularni čavli,
kompresijske pločice s limitiranim kontaktom i pločice na zaključavanje. Kako bi se
prevenirala postoperativna ukočenost i bol, važno je što ranije početi s aktivnim
pokretanjem zgloba kako bi se očuvala njegova funkcija i stabilnost.

Abstract (english)

The elbow is a trochoginglymoid joint that is, biomechanically speaking, one of the
most complex ones in the human body. The incidence of distal humerus fractures
has a bimodal peak, with the first one being in the age of twelve to nineteen years
and the other in the age over eighty.
Distal humerus fractures in younger people are usually caused by high energy
injuries, such as car accidents. In older people, who are also more exposed to
fractures due to osteoporosis, distal humerus fractures are usually caused by low
energy trauma, such as falling from a standing height. According to the AO classification
of distal humerus fractures, type A fractures are the most common
fracture type, second ones being type B fractures and the least common fracture type
being type C fractures.
Distal humerus fractures can be treated nonoperatively and operatively.
Nonoperative treatment is rarely recommended for younger patients. It is most
commonly used when the patients have a high risk of developing complications from
a surgical procedure. It can also be used to treat fractures with no dislocation.
Nonoperative management techniques include above-elbow cast, elbow braces and
supports, olecranon traction, and collar and cuff treatment, the so called “bag of
bones” method.
Operative managment is the most common way to treat distal humerus fractures.
Fractures with injuries to the vascular or neural structures must be operated
immediately. It is important to take a precise patient's history to find out as much as
possible about the injury mechanism. Fracture type is determined with the use of an
x-ray image of the fractured bone.
Open reduction and internal fixation with the use of plates to keep the joint stable are
useful for early active movement in the joint to keep its function and mobility.
Nowadays, there are many tools used for operating on the distal humerus, such as
cortical and cancellous screws, LC-DC plates and LCPs. To prevent postoperative
stiffness and pain, early active joint movement is the key to keeping the joint
functioning and stable.

• Keywords: prijelomi; distalni humerus; operativno liječenje; neoperativno liječenje
• Keywords (english): fractures; distal humerus; operative management; nonoperative management
• Language: croatian
• URN:NBN: urn:nbn:hr:105:401783
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-03-06 09:34:28