A comprehensive study of proximal humerus fractures and osteosynthesis in adult

Abstract

Background: Proximal humerus fractures are one of the commonest fractures accounting approximately 4–5% of the fracture attendance at the hospital. They occur more commonly in elderly patients, after cancellous bone of the humeral neck has weakened by senility but these fractures are seen in patients of all ages & merge with epiphyseal separations. Because of increasing incidence of high velocity trauma, complicated fracture patterns are becoming increasingly common. It has been always enigma of management because of numerous muscles attachment and paucity of space for fixing implant. Preservation of function and prevention of complication is the goal of any surgery. A prospective study was done to understand the various patterns and displacements of proximal humerus fracture and how these fractures behave to different types of surgical modalities being offered. So at the end of the study, some tentative conclusions can be drawn: (A) Type of treatment options could be offered for various fracture patterns, taking in considering age, occupation, expectations and associated problems (B) Steps and care should be taken to minimize the complications (C) Ideal time of rehabilitation programMethods: In this study, 55 patients presented to the Orthopedic Unit C (Wednesday and Saturday), V. S. General Hospital and N.H.L. Medical College (Gujarat University, Ahmedabad) with proximal humerus fractures from April 2009 to March 2012 were included and treated with various surgical modalities. All patients were followed-up for minimum 2 years and final outcome assessment included all the complications, ASES and Neer’s scoring.Results: Type of fracture and mode of fixation are the two most important factors determining the results amongst all. In our study, we have fond that average chances of getting excellent to satisfactory results lies between 65–80%. Proper understanding of fracture pattern, appropriate mode of fixation and timely physiotherapy are the keys to achieve good results even in seemingly difficult cases.