Neer tip II
tip III humerus proksimal uç kırıklı hastaları opere edelim mi? / Should we operate on patients with neer type II / type III proximal humeral fractures?
Yazar: SONER ÖZDEMİR
Danışman: DOÇ. DR. TAŞKIN ALTAY
Sağlık Bilimleri Üniversitesi / İzmir Bozyaka Eğt. ve Arş. Hast. / Ortopedi ve Travmatoloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2019
Konu: Ortopedi ve Travmatoloji = Orthopedics and Traumatology
Dizin: Cerrahi = Surgery ; Humeral kırıklar = Humeral fractures ; Humeral kırıklar = Humeral fractures ; Humerus = Humerus ; Konservatif tedavi = Conservative therapy ; Ortopedi = Orthopedics

Özet:
AMAÇ: Neer Tip II ve Neer Tip III humerus proksimal uç kırığı nedeniyle anatomik kilitli plakla cerrahi tedavi uygulanan hastalar ve konservatif tedavi edilenler arasında postop dönemde fonksiyonel açıdan fark olup olmadığını retrospektif olarak incelemek.
GEREÇ VE YÖNTEM: Ocak 2010-Ocak 2018 tarihleri arasında kliniğimize veya acil servise başvuran, Neer Tip II ve Neer Tip III proksimal humerus kırığı nedeniyle anatomik kilitli plakla cerrahi tedavi uyguladığımız ve konservatif olarak tedavi edilen, epifizi kapanmış, takiplere gelen ve fizik tedavi rehabilitasyon programına uyan toplam 73 hasta çalışmaya dahil edildi. 73 hastanın 43'üne anatomik kilitli plakla cerrahi tedavi ve 30'una konservatif tedavi uygulanmıştı. Ortalama 33 ay (12 - 60 ay) takip edilen hastalar son kontrollerinde Constant omuz skorlamasına ve Q.DASH skorlamasına göre değerlendirildiler.
BULGULAR: Değerlendirilen hastalardan konservatif takip edilen 30 hastanın  15'i kadın 15'i erkekti. Yaş ortalamaları 54,86 ± 14,31 olan gurubun 16'sı Neer Tip II, 14'ü Neer Tip III kırığa sahipti. Ortalama 33.40 ± 11.18 (12-60) ay izlenen hastaların Constant skorları ortalaması  83,43 ± 11,75, Q.DASH ortalaması 14,66 ± 12,53'dir. Cerrahi tedavi uygulanan 43 hastanın ise 22'si kadın, 21'i erkekti. Yaş ortalamaları 54,37 ± 17,22 olan gurubun 18'i Neer Tip II, 25'i ise Neer Tip III kırığa sahipti. Ortalama 30.33 ± 11.15 ay takip edilen edilen hastaların Constant skor ortalaması 81,18 ± 14,21, Q.DASH skor ortalaması 15,81 ± 15,64'dür.
Konservatif tedavi edilen Neer Tip II kırığa sahip 16 hastanın Constant skorları ortalaması 88,31 ± 6,42, Q.DASH skorları ortalaması 10,00 ± 4,64 idi. Neer Tip II kırığa sahip opere edilen 18 hastanın ise Constant Skorları ortalaması 81,77 ± 15,96, Q.DASH skorları ortalaması 16,05 ± 16,45 idi.
Konservatif tedavi edilen Neer Tip III kırığa sahip 14 hastanın Constant skorları ortalaması 77,85 ± 14,06, Q.DASH skorları ortalaması 20,00 ± 16,37'dir. Neer Tip III kırığa sahip opere edilen 25 hastanın ise Constant Skorları ortalaması 80,76 ± 13,13'tür., Q.DASH skorları ortalaması 15,64 ± 15,36 idi.
SONUÇ: Çalışmada Neer Tip II  ve Neer Tip III humerus proksimal uç kırığı bulunan hastaların anatomik kilitli plakla cerrahisi ve konservatif tedavileri arasında fonksiyonel manada istatistiksel olarak anlamlı fark bulunmamaktadır. Hastaların tedavilerine karar verilmesi aşamasında, iki tedavi yönteminden herhangi birinin üstün olduğuna dair bulgu saptanmadı.

Abstract:
AIM: Is there any functional outcomes difference between surgical treatment or conservative treatment of patients who had Neer Type II or Neer Type III proximal humeral fracture. 
	MATERIALS AND METHODS: Between January 2010 and January 2018, 73 patients admitted to our clinic or emergency department with Neer Type II and Neer Type III proximal humerus fractures were treated with anatomically locked plate or treated conservatively. 43 of 73 patients underwent surgical treatment with anatomically locked plate and 30 of them underwent conservative treatment. The patients were followed up for a mean of 33 months (12-60 months) and were evaluated according to Constant shoulder score and Q.DASH score at the last follow-up.
	RESULTS: Of the 30 patients that were evaluated conservatively, 15 were female and 15 were male. Mean age of the group was 54.86 ± 14.31 years. 16 of the conservatively treated group had Neer Type II fractures and 14 had Neer Type III fractures. The mean follow-up of the patients was 33.40 ± 11.18 months. The mean Constant score was 83.43 ± 11.75 and the mean Q.DASH score was 14.66 ± 12.53. Of the 43 patients who underwent surgical treatment, 22 were female and 21 were male. The mean age of the group was 54.37 ± 17.22 and 18 had Neer Type II fractures and 25 had Neer Type III fractures. The mean follow-up of patients was 30.33 ± 11.15 months. The mean score of Constant score was 81.18 ± 14.21 and the mean Q.DASH score was 15.81 ± 15.64.
The mean Constant scores of 16 patients with Neer Type II fractures treated conservatively were 88.31 ± 6.42 and the mean Q.DASH scores were 10.00 ± 4.64. Of the operated patients, 18 patients with Neer Type II fractures treated surgery had a mean Constant Score of 81.77 ± 15.96 and a mean Q.DASH score of 16.05 ± 16.45.
	14 patients with Neer Type III fractures treated conservatively had a mean Constant score of 77.85 ± 14.06 and a mean Q.DASH score of 20.00 ± 16.37.  25 patients with Neer Type III fractures treated surgery had a mean Constant Scores were 80.76 ± 13.13 and a mean Q.DASH scores were 15.64 ± 15.36.

	In our study, there was no statistically significant difference between anatomically locked plate surgery and conservative treatment of patients with Neer Type II and Neer Type III humerus proximal fractures. We found that both treatment methods were not superior to each other when deciding the treatment of the patients.