Halder humeral nailing systemを用いた上腕骨近位端骨折の治療経験

Proximal Humeral Fractures Treated with the Halder Humeral Nailing System

　抄録：大きな転位を伴う上腕骨近位端骨折は保存的治療に難渋するため，手術療法を行うことが多い．本骨折の骨接合術に関して留意すべき点は上腕骨頭への血流や腋窩神経を障害しないことなどであるが，Halder humeral nailing systemはこれらを満たすインプラントである．今回この新しいシステムを用い，本骨折5例を骨接合した．術後の日本整形外科学会（JOA）肩関節機能評価は平均79.4点，JOA肘関節機能評価は平均83点であった．仮骨の早期出現により，早期リハビリテーション開始が可能であった．髄内釘刺入部である肘関節への影響は少なかった．

　We have been performing surgery to treat some proximal humeral fractures with severe displacement.

　When performing proximal humeral surgery, it is important to preserve the blood supply to the humeral head and axillary nerve. We considered the Halder humeral nailing system, which is a new retrograde intramedullary nailing system, to be an improvement, because the soft tissue around proximal humerus is not injured, and we have tried using it to treat some proximal humeral fractures surgically.

　In this report on our experience with the use of the Halder humeral nailing system to perform open reduction and internal fixation of five humeral proximal fractures, one of which was a case of delayed union. We evaluated the results based on the Japan Orthopedic Association (JOA) shoulder and elbow scores.

　Radiological evidence of fracture union was observed after a mean interval of two weeks postoperatively, excluding the delayed union case. The mean JOA shoulder score was 79.4 points, and the mean JOA elbow score was 83.0 points. The approach to the olecranon fossa had few complications on the function of the elbow. Our experience indicates that the Halder system is a good alternative choice for the surgical treatment of proximal humeral fractures.