Functional outcome in displaced proximal humeral fractures in adults treated by proximal humeral locking plates

Authors

  • N. V. Narasimha Rao Department of Orthopaedics, G.S.L. Medical College, Rajahmundry, Andhra Pradesh
  • K. Ravi Kanth Department of Orthopaedics, G.S.L. Medical College, Rajahmundry, Andhra Pradesh
  • Rama Priya Yasam Department of Orthopaedics, G.S.L. Medical College, Rajahmundry, Andhra Pradesh
  • T. Jaya Chandra Central Research Laboratory, G.S.L. Medical College, Rajahmundry, Andhra Pradesh

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20195813

Keywords:

Fracture, Patient, Humerus

Abstract

Background: The management of proximal humerus fractures (PHF) is a challenging task to any surgeon. Study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system in fixation of displaced proximal humeral fractures.

Methods: Study was conducted in the Department of Orthopedics, GSL Medical College. Informed written consent was taken from the study participants. All skeletally mature patients aged >18 years, presenting with displaced PHF according to Neer two, three and four part fracture were included in the study. Either deltopectoral or deltoid splitting approach was used for surgery, post-operative rehabilitation was started on day one.

Results: Twenty-five patients with PHF were enrolled in the study; five-holed proximal humerus locking plate (PHLP) was used for 18 patients, eight-holed PHLP for 05 and three-holed, ten-holed PHLP for 01 for one each. The Constant-Murley score was significantly improved (p=0.000) over each successive follow-up period with the average improvement of around 19 scores between 1st and 2nd follow-up and around 15 score improvement between 2nd and 3rd follow-up.

Conclusions: The proximal humeral locking plate is an adequate device for the fixation of displaced two-part, three-part and four-part PHF. Patient can regain good shoulder function, resume normal activities much earlier.

References

Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-71.

Kristiansen B, Barfod G, Bredesen J, Erin-Madsen J, Grum B, Horsnaes MW, et al. Epidemiology of proximal humeral fractures. Acta Orthop Scand. 1987;58(1):75-7.

Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87-92.

Holloway KL, Bucki-Smith G, Morse AG, Brennan-Olsen SL, Kotowicz MA, Moloney DJ, et al. Humeral Fractures in South-Eastern Australia: Epidemiology and Risk Factors. Calcif Tissue Int. 2015;97(5):453-65.

Sumrein BO, Huttunen TT, Launonen AP, Berg HE, Felländer-Tsai L, Mattila VM. Proximal humeral fractures in Sweden-a registry-based study. Osteoporos Int. 2017;28(3):901-7.

Park C, Jang S, Lee A, Kim HY, Lee YB, Kim TY. Incidence and mortality after proximal humerus fractures over 50 years of age in South Korea: national claim data from 2008 to 2012. J Bone Metab. 2015;22(1):17-21.

Karl JW, Olson PR, Rosenwasser MP. The Epidemiology of Upper Extremity Fractures in the United States, 2009. J Orthop Trauma. 2015;29(8):e242-4.

Lind T, Krøner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg. 1989;108(5):285-7.

Boileau P, Walch G. The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br. 1997;79(5):857-65.

Burkhart KJ, Dietz SO, Bastian L, Thelen U, Hoffmann R, Müller LP. The treatment of proximal humeral fracture in adults. Dtsch Arztebl Int. 2013;110(35–36):591-7.

Bhandari M, Matthys G, McKee MD, Evidence-Based Orthopaedic Trauma Working Group. Four part fractures of the proximal humerus. J Orthop Trauma. 2004;18(2):126-7.

Neer CS. Displaced proximal humeral fractures. Part I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077-89.

Buecking B, Mohr J, Bockmann B, Zettl R, Ruchholtz S. Deltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures? Clin Orthop Relat Res. 2014;472(5):1576-85.

Brorson S. Management of Proximal Humeral Fractures in the Nineteenth Century: An Historical Review of Preradiographic Sources. Clin Orthop Relat Res. 2011;469(4):1197-206.

Darder A, Darder A, Sanchis V, Gastaldi E, Gomar F. Four-part displaced proximal humeral fractures: operative treatment using Kirschner wires and a tension band. J Orthop Trauma. 1993;7(6):497-505.

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160-4.

Moeller AD, Thorsen RR, Torabi TP, Bjoerkman A-SD, Christensen EH, Maribo T, et al. The Danish version of the modified Constant-Murley shoulder score: reliability, agreement, and construct validity. J Orthop Sports Phys Ther. 2014;44(5):336-40.

Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg. 2009;18(6):837-44.

Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7.

Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C, et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res. 2012;98(6):715-9.

Vijayvargiya M, Pathak A, Gaur S. Outcome Analysis of Locking Plate Fixation in Proximal Humerus Fracture. J Clin Diagn Res. 2016;10(8):RC01-5.

Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus: A retrospective analysis of 82 cases treated with the Philos locking plate. Injury. 2014;45(6):S43-8.

Menendez ME, Ring D. Does the timing of surgery for proximal humeral fracture affect inpatient outcomes? J Shoulder Elbow Surg. 2014;23(9):1257-62.

Sinha S, Kelly CP. Fixed angle locking plates for proximal humeral fracture fixation. Ann R Coll Surg Engl. 2010;92(8):631-4.

Euler SA, Hengg C, Wambacher M, Spiegl UJ, Kralinger F. Allogenic bone grafting for augmentation in two-part proximal humeral fracture fixation in a high-risk patient population. Arch Orthop Trauma Surg. 2015;135(1):79-87.

Buecking B, Mohr J, Bockmann B, Zettl R, Ruchholtz S. Deltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures? Clin Orthop Relat Res. 2014;472(5):1576-85.

Waliullah S, Kumar A. Difference between radiological and functional outcome with deltoid-splitting approach versus deltopectoral approach for the management of proximal humeral fractures with philos plate. Journal of Orthopaedics and Allied Sciences. 2013;1(1):14.

Aksu N, Gogus A, Kara AN, Işiklar ZU. Complications encountered in proximal humerus fractures treated with locking plate fixation. Acta Orthop Traumatol Turc. 2010;44(2):89-96.

Geiger EV, Maier M, Kelm A, Wutzler S, Seebach C, Marzi I. Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthop Traumatol Turc. 2010;44(1):1-6.

Lacobellis C, Fountzoulas K, Aldegheri R. Plating of proximal fracture of the humerus: a study of 30 cases. Musculoskelet Surg. 2011;95(1):S43-8.

Fazal MA, Haddad FS. Philos plate fixation for displaced proximal humeral fractures. J Orthop Surg (Hong Kong). 2009;17(1):15-8.

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Published

2019-12-24

Issue

Vol. 6 No. 1 (2020): January-February 2020

Section

Original Research Articles