Proximal humeral internal locking osteosynthesis for surgical fixation for displaced two part to four part fractures: A prospective study

Author(s): Dr. Varun Manek, Dr. K Venkatachalam and Dr. Vijaynarasimman Reddy

Abstract: Secure fixation of displaced proximal fractures of the humerus is a challenging problem. Proximal humeral fractures constitute about 5 percent of all upper extremity fractures. They are often considerably displaced and communited in the elderly. About 66 percent of these fractures occur in patient above the age of 60 years. The female to male ratio is about 3:1 and the incidence of this fracture increases with age. It is in these older patients, that the mechanism of injury is usually a low energy trauma. As majority of these fractures occur in the osteoporotic bone, the operative treatment with locking compression plate has of late become the gold standard. The aim of the present study is to analyse prospectively, 45 cases of proximal humeral peri-articular fractures, occurring in the osteoporotic bone of the elderly, in the age group of 50 to 69 years treated surgically with PHILOS plating. It is to study their radiological and functional outcome score so the clinical outcomes and then to compare it with published literature. Also, comparison shall be made as to the time elapsed from injury to surgery, the surgery duration, the loss of blood during surgery, post-op complications and the time required for radiological bony union. In our series, the clinical outcome assessed as per the Constant Shoulder Score, achieved 44.45% fair, 40% good and 11.11% excellent results. We had 4.44% of poor outcomes. Our study conclusively shows that LCP should be considered as a gold standard in treating displaced peri-articular proximal humeral fractures especially in the elderly with osteoporotic bone. These implants provide greater angular stability, better biomechanical properties and enhanced anchorage in these complex injuries. The goal of the treatment is primarily to restore a painless shoulder with reasonably satisfactory function.

DOI: https://doi.org/10.22271/ortho.2018.v4.i2j.93