Utilidad de la tomografía en el diagnóstico y tratamiento de fracturas proximales del humero en tres y cuatro partes en mayores de 65 años

Abstract

Proximal humeral fractures in three and four parts presented in patients older than 65 years are a diagnostic and therapeutic challenge due to its complexity. Neer classification has been a helpful tool for the characterization and treatment of fractures of the proximal humerus and is based on radiographic evaluation which can not make clear complex fractuares patterns; computed tomography can identify these complex patterns which are common in patients over 65 years, even so, it is not clear the tomography impact. This study is intended to show whether there is a change in the classification and indication of management for fractures in three and four parts of the proximal humerus assessed with radiographs to be subsequently measured with tomography. 15 experts reviewers interpret and indicate treatment of 20 radiographic studies of fractures in three and four parts of the proximal humerus of patients over 65 years, previously asymptomatic, functional with isolated fracture , then the tomographic assessment is conducted and related to radiographic results, then the evidence whether or not there is a change in the classification and management of fractures is seen. Through an observational, descriptive and retrospective study we find that the evaluation of the tomography can vary the classification and treatment initially indicated by radiographic studies in 60.3% and 54.3% respectively, with a variation of conduct in over half of the cases there is seen the need for the tomographic study.