{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T09:22:40Z","timestamp":1766136160105,"version":"3.45.0"},"reference-count":0,"publisher":"AVES YAYINCILIK A.\u015e.","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["AOTT"],"abstract":"<jats:p>Abstract\n\nObjectives: We evaluated the functional results of open reduction and internal fixation with a locking plate in patients with three- or four-part fractures of the proximal humerus.\\r\\nMethods: We reviewed 32 consecutive patients (22 women, 10 men; mean age 63 years; range 29 to 82 years) who were treated with open reduction and internal fixation using the PHILOS locking plate for comminuted proximal humeral fractures. According to the Neer classification, 12 patients (mean age 56 years) had three-part fractures, 19 patients (mean age 67 years) had four-part fractures, and one patient had a four-part fracture dislocation. Ten patients were in the age group of &lt;60 years, 22 patients were in the age group of 60?years. All the patients were evaluated with plain radiographs preoperatively; in addition, computed tomography was used in 14 patients in whom articular surface and tuberculum displacement could not be assessed adequately. The operation was performed through a standard deltopectoral approach, and minimal soft tissue dissection was used aiming not to impair vascularization of the fracture fragments. A cerclage wire was used to help reduction in 12 patients. An oblique screw was inserted to stabilize the medial colon in cases in which medial cortical contact was insufficient. Bone grafting was not used in any of the patients. Active-assisted and passive exercises of the shoulder were initiated on the second postoperative day. Active abduction to 90 degrees was allowed two weeks after surgery. During follow-up, implant failure, loss of reduction, malunion, and bone healing were assessed on plain radiographs. Bone scintigraphy was performed after 12 postoperative months for the detection of avascular necrosis. The results were assessed using the Constant shoulder score. The mean follow-up period was 25 months (range 18 to 36 months).\\r\\nResults: An anatomic or near-anatomic reduction was obtained in 29 patients (90.6%). In two patients, the fractures were fixed in a varus position, and in one patient, the greater tubercle was displaced proximally. All fractures united in a mean of three months (range 2 to 5 months). The mean Constant score of the patients was 79.5 (range 50 to 100). The results were excellent in 13 patients (40.6%), good in nine patients (28.1%), fair in eight patients (25%), and poor in two patients (6.3%). The mean Constant scores were 88.3 (range 69 to 100) and 74.2 (range 50 to 100) in three-part and four-part fractures, and 88.3 (range 71 to 100) and 75.5 (range 50 to 100) in the age groups of &lt;60 years and ?60 years, respectively. Constant scores showed significant differences with respect to the number of comminution and age groups (p=0.03). Avascular necrosis was observed in two patients. None of the patients had reduction loss, implant failure, deep infection, or neurovascular injury, and none required implant removal.\\r\\nConclusion: Preservation of humeral head vascularity through minimal soft tissue dissection, fixation with a locking plate, and early postoperative motion were effective in decreasing potential complications following surgical treatment of three- and four-part proximal humeral fractures. The degree of fracture comminution and age of the patients affect functional results significantly.\n\n\n\u00d6zet\n\nAma\u00e7: \u00dc\u00e7 ve d\u00f6rt par\u00e7al\u0131 proksimal humerus k\u0131r\u0131\u011f\u0131 nedeniyle a\u00e7\u0131k red\u00fcksiyonla kilitli plak tespiti uygulanan hastalarda fonksiyonel sonu\u00e7lar de\u011ferlendirildi.\\r\\n\u00c7al\u0131\u015fma plan\u0131: Proksimal humerus par\u00e7al\u0131 k\u0131r\u0131k nedeniyle a\u00e7\u0131k red\u00fcksiyon ve PHILOS kilitli plakla tespit uygulanan 32 ard\u0131\u015f\u0131k hasta (22 kad\u0131n, 10 erkek; ort. ya\u015f 63; da\u011f\u0131l\u0131m 29-82) geriye d\u00f6n\u00fck olarak de\u011ferlendirildi. Neer s\u0131n\u0131flamas\u0131na g\u00f6re, 12 hastada (ort. ya\u015f 56) \u00fc\u00e7 par\u00e7al\u0131 k\u0131r\u0131k, 19 hastada (ort. ya\u015f 67) d\u00f6rt par\u00e7al\u0131 k\u0131r\u0131k, bir hastada da d\u00f6rt par\u00e7al\u0131 k\u0131r\u0131kl\u0131 \u00e7\u0131k\u0131k vard\u0131. Hastalar\u0131n 10\u2019u 60 ya\u015f\u0131n alt\u0131nda, 22\u2019si 60 ya\u015f veya \u00fczerinde idi. Ameliyat \u00f6ncesinde t\u00fcm hastalar d\u00fcz grafilerle incelendi; eklem y\u00fczeyi hakk\u0131nda yeterli bilgi elde edilemeyen 14 hastada bilgisayarl\u0131 tomografiye ba\u015fvuruldu. Ameliyatta standart deltopektoral insizyon kullan\u0131larak, k\u0131r\u0131k par\u00e7alar\u0131n damarlanmas\u0131n\u0131n daha fazla bozulmas\u0131n\u0131 \u00f6nlemek i\u00e7in minimal yumu\u015fak doku diseksiyonu yap\u0131ld\u0131. On iki hastada ameliyat s\u0131ras\u0131nda red\u00fcksiyona yard\u0131mc\u0131 olmak i\u00e7in serklaj teli kullan\u0131ld\u0131. Medialden yeterli kortikal temas\u0131n sa\u011flanamad\u0131\u011f\u0131 olgularda oblik bir vida ile medial destek sa\u011fland\u0131. Ameliyatta kemik grefti kullan\u0131lmad\u0131. Ameliyat sonras\u0131 ikinci g\u00fcnde yard\u0131ml\u0131 aktif ve pasif hareketlere ba\u015fland\u0131. Ameliyat sonras\u0131 ikinci haftada 90 dereceye kadar aktif omuz abd\u00fcksiyonuna izin verildi. Takipler s\u0131ras\u0131nda d\u00fcz radyografilerde implant yetmezli\u011fi, red\u00fcksiyon kayb\u0131, yanl\u0131\u015f kaynama ve k\u0131r\u0131k kaynamas\u0131 ara\u015ft\u0131r\u0131ld\u0131. Avask\u00fcler nekroz geli\u015fimi, t\u00fcm hastalarda 12 aydan sonra \u00e7ekilen kemik sintigrafisi ile kontrol edildi. Son kontrollerde hastalar Constant skoru ile de\u011ferlendirildi. Ortalama takip s\u00fcresi 25 ay (da\u011f\u0131l\u0131m 18-36 ay) idi.\\r\\nSonu\u00e7lar: Otuz iki hastan\u0131n 29\u2019unda (%90.6) tam anatomik veya anatomi\u011fe yak\u0131n red\u00fcksiyon sa\u011fland\u0131. \u0130ki hastada ameliyat s\u0131ras\u0131nda k\u0131r\u0131klar varus pozisyonunda tespit edildi, bir hastada ameliyat sonras\u0131 erken d\u00f6nemde b\u00fcy\u00fck t\u00fcberk\u00fcl\u00fcn proksimale yer de\u011fi\u015ftirmi\u015f oldu\u011fu g\u00f6r\u00fcld\u00fc. T\u00fcm k\u0131r\u0131klar ortalama \u00fc\u00e7 ayda (da\u011f\u0131l\u0131m 2-5 ay) kaynad\u0131. Ortalama Constant skoru 79.5 (da\u011f\u0131l\u0131m 50-100) bulundu. On \u00fc\u00e7 hastada (%40.6) m\u00fckemmel, dokuz hastada (%28.1) iyi, sekiz hastada (%25) orta, iki hastada (%6.3) k\u00f6t\u00fc sonu\u00e7 elde edildi. Ortalama Constant skoru \u00fc\u00e7 ve d\u00f6rt par\u00e7al\u0131 k\u0131r\u0131klarda s\u0131ras\u0131yla 88.3 (da\u011f\u0131l\u0131m 69-100) ve 74.2 (da\u011f\u0131l\u0131m 50-100), 60 ya\u015f alt\u0131 ve \u00fcst\u00fcndeki hastalarda s\u0131ras\u0131yla 88.3 (da\u011f\u0131l\u0131m 71-100) ve 75.5 (da\u011f\u0131l\u0131m 50-100) idi. Constant skoru k\u0131r\u0131k par\u00e7a say\u0131s\u0131na ve ya\u015f grubuna g\u00f6re anlaml\u0131 farkl\u0131l\u0131k g\u00f6sterdi (p=0.03). Avask\u00fcler nekroz iki hastada g\u00f6r\u00fcld\u00fc. Hi\u00e7bir hastada red\u00fcksiyon kayb\u0131, implant yetmezli\u011fi, derin enfeksiyon, n\u00f6rovask\u00fcler yaralanma g\u00f6zlenmedi, implant\u0131n \u00e7\u0131kar\u0131lmas\u0131 gerekmedi.<\/jats:p>","DOI":"10.3944\/aott.2010.2275","type":"journal-article","created":{"date-parts":[[2010,7,15]],"date-time":"2010-07-15T04:05:54Z","timestamp":1279166754000},"page":"97-104","source":"Crossref","is-referenced-by-count":18,"title":["Locking plate fixation of three and fourpart proximal humeral fractures"],"prefix":"10.5152","volume":"44","author":[{"given":"Atilla","family":"Sancar Parmaks\u0131zoglu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sami","family":"Sokucu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ufuk","family":"Ozkaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yavuz","family":"Kabukcuoglu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat","family":"Gul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3111","published-online":{"date-parts":[[2020,2,8]]},"container-title":["Acta Orthopaedica et Traumatologica Turcica"],"original-title":[],"link":[{"URL":"https:\/\/aott.org.tr\/index.php\/pub\/article\/download\/2365\/2322","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T10:56:41Z","timestamp":1763463401000},"score":1,"resource":{"primary":{"URL":"https:\/\/aott.org.tr\/index.php\/pub\/article\/view\/2365"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,8]]},"references-count":0,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2010,1,2]]}},"URL":"https:\/\/doi.org\/10.3944\/aott.2010.2275","relation":{},"ISSN":["2589-1294","1017-995X"],"issn-type":[{"type":"electronic","value":"2589-1294"},{"type":"print","value":"1017-995X"}],"subject":[],"published":{"date-parts":[[2020,2,8]]}}}