A study of factors which influence the outcome in fracture dislocations of proximal humerus treated by open reduction and internal fixation with philos plate
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20252656Keywords:
AVN, ORIF, Proximal humerus fracture dislocation, Philos plate, TraumaAbstract
Management of proximal humerus fracture dislocation is challenging owing to the possibility of multiple complications including avascular necrosis. Literature remains controversial regarding the mode of management Osteosynthesis vs arthroplasty and the pros and cons of one over the other, particularly in elderly age groups. This is a case series include 20 patients admitted with proximal humerus fracture dislocation and were treated with open reduction internal fixation with proximal humerus internal locking osteosynthesis systems (PHILOS) plate. Post operatively, serial X-rays were taken at post-operative day 1, 1 month, 6 months and at 1 year to assess the union. Clinically patients were assessed with constant Murley score at the end of 1 year. The mean constant-Murley score at the end of 1 year was found to be 70.8 with 86 being the highest and 42 being the least and it has a strong negative correlation with increasing age. 5% of the patients developed avascular necrosis and remaining 95% united well. The result also shows that the chances of occurrence of AVN humeral head is proportional to the duration of surgery since injury. We conclude that osteosynthesis for proximal humerus fracture dislocation gives good outcome including the elderly patients. Early fixation, anatomic reduction, meticulous placement of implant and minimal soft tissue stripping and adherence to appropriate and regular rehabilitation program can give better functional outcome irrespective of the age of the patient. The learning curve with the implant chosen and surgeon’s skill play a major role in the final outcome.
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Iglesias-Rodríguez S, Domínguez-Prado DM, García-Reza A, Fernández-Fernández D, Pérez-Alfonso E, García-Piñeiro J, Castro-Menéndez M. Epidemiology of proximal humerus fractures. J Orthopaed Surg Res. 2021;16(1):402. DOI: https://doi.org/10.1186/s13018-021-02551-x
Haupt S, Frima H, Sommer C. Operative Treatment of Proximal Humeral Fracture-dislocations Through an Anterolateral Deltoid Split Approach. Arch Bone J Surg. 2020;8(5):589-97.
Gavaskar AS, Pattabiraman K, Srinivasan P, Raj RV, Jayakumar B, Rangasamy NK. What factors are associated with poor shoulder function and serious complications after internal fixation of three-part and four-part proximal humerus fracture-dislocations. Clin Orthopaed Related Res. 2022;480(8):1566-73. DOI: https://doi.org/10.1097/CORR.0000000000002190
Schnetzke M, Bockmeyer J, Loew M, Studier-Fischer S, Grützner PA, Guehring T. Rate of avascular necrosis after fracture dislocations of the proximal humerus: Timing of surgery. Obere Extrem. 2018;13(4):273-8. DOI: https://doi.org/10.1007/s11678-018-0452-6
Alberio RL, Del Re M, Grassi FA. Minimally Invasive Plate Osteosynthesis for Proximal Humerus Fractures: A Retrospective Study Describing Principles and Advantages of the Technique. Adv Orthop. 2018;3;28:5904028. DOI: https://doi.org/10.1155/2018/5904028
Vrotsou K, Ávila M, Machón M, Mateo-Abad M, Pardo Y, Garin O, et al. Constant-Murley Score: systematic review and standardized evaluation in different shoulder pathologies. Qual Life Res. 2018;27(9):2217-6. DOI: https://doi.org/10.1007/s11136-018-1875-7
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160-4. DOI: https://doi.org/10.1097/00003086-198701000-00023
Campochiaro G, Rebuzzi M, Baudi P, Catani F. Complex proximal humerus fractures: Hertel’s criteria reliability to predict head necrosis. Musculoskelet Surg. 2015;99(1):9-15. DOI: https://doi.org/10.1007/s12306-015-0358-z
Fukuda A, Nishimura A, Kato K, Sudo A. Arthroscopically assisted minimally invasive plate osteosynthesis for posterior fracture–dislocation of the shoulder. J Orthopaed Sci. 2014;19(1):194-7. DOI: https://doi.org/10.1007/s00776-012-0284-y
O’Neill D, Nair JR, Binymin KA. Simultaneous bilateral posterior fracture dislocation of the shoulders in a young man with unexpected severe vitamin D deficiency. Int J Gen Med. 2012;5:399–402. DOI: https://doi.org/10.2147/IJGM.S29351
Degnek O. Clinical and radiologic results of open reduction and fixation with locked plate screws in proximal humerus fracture– dislocation. J Clin Anal Med. 2019;10:83-8. DOI: https://doi.org/10.4328/JCAM.5859
Soliman OA, Koptan WM. Four-part fracture dislocations of the proximal humerus in young adults: results of fixation. Injury. 2013;44(4):442-7. DOI: https://doi.org/10.1016/j.injury.2012.09.005
Trikha V, Singh V, Choudhury B, Das S. Retrospective analysis of proximal humeral fracture-dislocations managed with locked plates. J Shoulder Elbow Surg. 2017;26:293-9. DOI: https://doi.org/10.1016/j.jse.2017.03.035
Robinson CM, Akhtar A, Mitchell M, Beavis C. Complex posterior fracture-dislocation of the shoulder. Epidemiology, injury patterns and results of operative treatment. J Bone Joint Surg Am. 2007;89:1454-66. DOI: https://doi.org/10.2106/JBJS.F.01214
Padegimas EM, Nicholson TA, Chang G, Hebert-Davies J, Namdari S. Outcomes of open reduction and internal fixation of proximal humerus fracture dislocations. J Shoulder Elbow Surg. 2021;30(10):2331-5. DOI: https://doi.org/10.1016/j.jse.2021.01.025
Schirren M, Siebenb€urger G, Fleischhacker E, Biermann N, Helfen T, B€ocker W, et al. Anterior fracture dislocation of the proximal humerus. Obere Extrem. 2019;14:103-9. DOI: https://doi.org/10.1007/s11678-019-0509-1
Johnson N, Pandey R. Proximal humerus fracture–dislocation managed by mini-open reduction and percutaneous screw fixation. Shoulder Elbow. 2019;11:353-8. DOI: https://doi.org/10.1177/1758573218791815
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;45:43-8. DOI: https://doi.org/10.1016/j.injury.2014.10.022
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