Study of functional outcome of surgical management of proximal humerus fracture by various modalities: a two-year study at a tertiary care hospital
Keywords:Neer’s score, Humerus fracture, Range of motion, Functional outcome
Background: Proximal humerus fractures account for nearly 6-10% and are on a rise. The management of this is controversial and is challenging task. There is a significant heterogeneity among the studies in describing the best surgical procedure in proximal humerus fracture. The objective of the study is to assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures.
Methods: A two-year prospective study was conducted after getting ethical approval at Narayana Medical College on cases admitted with proximal humerus fractures as per the inclusion criteria based on Neer’s classification. Radiological evaluation was done, and surgery was performed. Postoperative follow-up was done at 1st, 4th, 8th and 14th week and outcome were evaluated for each case based on Neer’s shoulder score.
Results: 30 cases were included with a mean age of 48.2 years. Road traffic injury was common cause of fracture. Of the total 30 cases, 23 cases had excellent results, 4 cases were satisfactory, 2 cases were unsatisfactory, and one case had a failure. The mean scores observed on Neer’s score was pain (33.5 units), Function (23.5 units), range of motion (16.55 units) and anatomy (6.9 units).
Conclusions: Clinical evaluation, obtaining proper radiological views, age of the patient and activity holds the key for realistic approach and surgical management of complex humerus fractures. Proper patient selection and thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery and good functional outcome.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–7.
Clement ND. Management of Humeral Shaft Fractures; Non-Operative Versus Operative. Arch Trauma Res. 2015;4(2):e28013.
Kumar A, Waddell JP. Non-operative Management of Proximal Humerus Fractures. In: Biberthaler P, Kirchhoff C, Waddell J, eds. Fractures of the Proximal Humerus. Strategies in Fracture Treatments. Springer: Cham; 2015.
Carofino BC, Leopold SS. Classifications in brief: the Neer classification for proximal humerus fractures. Clin Orthop Relat Res. 2013;471(1):39–43.
Launonen AP, Lepola V, Saranko A, Flinkkilä T, Laitinen M, Mattila VM. Epidemiology of proximal humerus fractures. Arch Osteoporos. 2015;10:209.
Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthopaedica Scandinavica. 2001;4:365-71.
Nwachukwu BU, Schairer WW, McCormick F, Dines DM, Craig EV, Gulotta LV. Arthroplasty for the surgical management of complex proximal humerus fractures in the elderly: A cost-utility analysis. J Shoulder Elbow Surg. 2016;25(5):704-13.
Gerber C, Worner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg (Br). 2004;86(60):848-55.
Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with locking compression plate: A retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75:741-5.
Vijayvargiya M, Pathak A, Gaur S. Outcome analysis of locking plate fixation in proximal humerus fracture. J Clin Diag Res. 2016;10(8):1-5.
Doshi C, Sharma GM, Naik LG, Badgire KS, Qureshi F. Treatment of Proximal Humerus Fractures using PHILOS Plate. J Clin Diagn Res. 2017;11(7):10-3.
Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four‑part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919‑25.
Thyagarajan DS, Haridas SJ, Jones D, Dent C, Evans R, Williams R. Functional outcome following proximal humeral interlocking system plating for displaced proximal humeral fractures. Int J Shoulder Surg. 2009;3:57‑62.