A study of different surgical modalities in the management of proximal humerus fractures

Abstract

Background: Proximal humerus fractures are common but debilitating injuries. Numerous factors contribute to post injury functional outcomes; therefore, a large debate exists over appropriate treatment. Optimal treatment for displaced or unstable two, three, and four-part proximal humerus fractures remains controversial. This study is conducted to analyze the results of proximal humerus fractures treated by different modalities of surgical fixation. Materials & Methods: This study was carried out in Malla Reddy Institute of Medical Sciences, from July 2016 to June 2018. Thirty patients of displaced proximal humeral fractures were admitted in this hospital and treated surgically by PHILOS plate, K-wire and hemiarthroplasty. Follow up is done from 4 weeks to 12 months both clinically and radiologically. Results were evaluated by the use of Neer’s shoulder score. Results: Most common mode of injury was found to be road traffic accident and the most common type was two part fracture accounting for 12 out of 30 patients (40%).The results were evaluated by Neer’s score. The average follow up duration was 11.4 months. Of the thirty patients, 7 (23.3%) had excellent results, 17 (56.7%) had satisfactory results, 4 (13.3%) had unsatisfactory results and 2 (6.67%) were failure. Conclusions: Closed reduction and percutaneous pinning can be used for un-displaced or displaced fractures of the proximal humerus without comminution, in the younger age groups with good bone quality. In older individuals it is good to fix with percutaneous K wires, considering bone density (osteoporosis) and also to reduce the period of surgery. K wire fixation gave excellent results in our patients for the treatment of unstable 2 part proximal humerus fractures. Proximal humerus locking plate (PHILOS) gives reliable fixation for 2-part and 3-part fractures and has good functional outcome. In more complicated fracture patterns of 4-part fractures, its use is associated with poor clinical outcome. Prosthetic replacement should be considered as primary treatment in cases with marked comminution of the humeral head, in fracture-dislocations, and in elderly patients.