Study on the efficiency of locking plate surgery with that of inter locking nail treatment in management of proximal humerus fracture in P. T. Birta City Hospital and Research Center

Rupesh J. Belbase; Pradip Shah; Kumud K. Limbu; Alson Poudel; Anil Basnet; Romi Buohathoki; Dikshya Nepal

doi:10.18203/issn.2455-4510.IntJResOrthop20243890

Authors

Rupesh J. Belbase Department of Orthopaedics, P. T. Birta City Hospital and Research Center, Birtamod, Nepal
Pradip Shah Department of Orthopaedics, P. T. Birta City Hospital and Research Center, Birtamod, Nepal
Kumud K. Limbu Department of Orthopaedics, P. T. Birta City Hospital and Research Center, Birtamod, Nepal
Alson Poudel Department of Orthopaedics, P. T. Birta City Hospital and Research Center, Birtamod, Nepal
Anil Basnet Department of Medicine, P. T. Birta City Hospital and Research Center, Birtamod, Nepal
Romi Buohathoki Department of Administration, P. T. Birta City Hospital and Research Center, Birtamod, Nepal
Dikshya Nepal P. T. Birta City Hospital and Research Center, Birtamod, Nepal

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243890

Keywords:

Humoral fracture, Stress fracture, Locking plate surgery, Proximal humerus

Abstract

Background: Proximal humeral fractures (PHFs) commonly exhibit a bimodal distribution based on trauma energy levels, affecting mainly those over 65 through low-energy falls, often indicating osteoporosis. Treatment approaches for displaced PHFs vary, with locking plates offering high stability but posing risks to blood supply and nerves. The efficacy of surgical versus conservative treatments remains debated, especially for complex fractures, with studies linking surgical options like intramedullary nailing and locking plates to mixed outcomes, including possible shoulder limitations. Aims and objectives were to evaluate the efficiency of locking plate surgery with that of interlocking nail in treatment in management of PHF.

Methods: A prospective investigation was carried out on patients who visited our hospital's outpatient department. A general anaesthetic and brachial plexus block were delivered throughout the patients' procedures. Each operation was performed by the same team, which was proficient in both approaches. The study conducted t-test and Chi-square to analyze the data.

Results: The analysis found no significant demographic differences between the two groups (p>0.05). The non-operative group had significantly lower blood loss (71.8±10.5 ml) than the locking plate group (134.2±16.9 ml, p=0.000). Visual analog score (VAS) and Constant-Murley scores indicated greater shoulder function improvements for the locking plate group at three months (p<0.001), although no significant differences were observed at the final follow-up (p>0.05). Postoperative complications did not significantly differ between groups (p=0.337).

Conclusions: Locking plates reduce fractures faster than interlocking intramedullary nails. Both internal fixation techniques for proximal humerus fracture had similar pain and shoulder function scores.

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References

Barrett JA, Baron JA, Karagas MR, Beach ML. Fracture risk in the U. S. Medicare population. J Clin Epidemiol 1999;52:243-9.

Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53-72.

Donnally III CJ, DiPompeo CM, Varacallo M. Vertebral Compression Fractures. StatPearls. StatPearls Publishing; Treasure Island (FL). 2022.

Pencle FJ, Varacallo M. Proximal Humerus Fracture. PubMed; StatPearls Publishing. 2020.

Aiyer A, Varacallo M, Boateng H, Reid JS. Humeral Shaft Fracture with Ipsilateral Anterior Shoulder Dislocation and Posterior Elbow Dislocation: A Case Report and Review of the Literature. JBJS Case Connect. 2014;4(3):e77.

Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009;23:163-72.

Burstr€om K, Johannesson M, Diderichsen F. Swedish population health-related quality of life results using the EQ-5D. Qual Life Res. 2001;10:621-35.

Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M, et al. Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg. 2007;127:205-10.

Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg. 2010;19:489-94.

Constant C. Age related recovery of shoulder function after injury. Thesis. Cork, Ireland: University College; 1986.

Constant CR, Gerber C, Emery RJ, Sojbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008;17:355-61.

Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011;20(5):747-55.

Wang H, Liu Y, Wang D, He Y, Yao P, Lu T, et al. Predictive indicators for complications of proximal humerus fractures treated with locking plate or intramedullary nail fixation. Orthop Surg. 2022;14(9):2109-18.

Lambert SM. Ischaemia, healing and outcomes in proximal humeral fractures. EFORT Open Rev. 2018;3(5):304-15.

Gradl G, Dietze A, Kääb M, Hopfenmüller W, Mittlmeier T. Is locking nailing of humeral head fractures superior to locking plate fixation? Clin Orthop Relat Res. 2009;467(11):2986-93.

Neer CS 2nd. Displaced proximal humeral fractures I. classification and evaluation. J Bone Joint Surg Am. 1970;52(6):1077–89.

Lopiz Y, Garcia-Coiradas J, Garcia-Fernandez C, Marco F. Proximal humerus nailing: a randomized clinical trial between curvilinear and straight nails. J Shoulder Elbow Surg. 2014;23(3):369-76.

Xie L, Ding F, Zhao Z, Chen Y, Xing D. Operative versus non-operative treatment in complex proximal humeral fractures: A meta-analysis of randomized controlled trials. SpringerPlus. 2015;4(1).

Barlow JD, Logli AL, Steinmann SP, Sems SA, Cross WW, Yuan BJ, et al. Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. J Shoulder Elbow Surg. 2020;29(8):1689-94.

Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011;20(5):747-55.

Olerud P, Ahrengart L, Söderqvist A, Saving J, Tidermark J. Quality of life and functional outcome after a 2-part proximal humeral fracture: a prospective cohort study on 50 patients treated with a locking plate. J Shoulder Elbow Surg. 2010;19(6):814-22.

Konrad G, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg Am. 2010;92(1):85-95.

Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009;91(6):1320-8.

Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21(3):185-91.

Dilisio MF, Nowinski RJ, Hatzidakis AM, Fehringer EV. Intramedullary nailing of the proximal humerus: evolution, technique, and results. J Shoulder Elbow Surg. 2016;25(5):e130-8.

Davey MS, Hurley ET, Anil U, Condren S, Kearney J, O’Tuile C, et al. Management options for proximal humerus fractures - a systematic review & network meta-analysis of randomized control trials. Injury. 2022;53(2):244-9.

Matassi F, Angeloni R, Carulli C, Civinini R, Di Bella L, Redl B, et al. Locking plate and fbular allograft augmentation in unstable fractures of proximal humerus. Injury. 2012;43(11):1939-42.