Management of proximal humeral fractures by the Ilizarov external fixator

Abstract Background: For adolescents of severely displaced proximal humeral fracture (PHF), surgery is a good choice yielding excellent outcomes. Kirchner wire (KW) is a cost-effective choice for fixation, and this study aims to compare the clinical outcomes of external fixator (EF) vs. KW for the treatment of PHF in adolescents. To the best of our knowledge, it is the first report on external fixator for PHF in children and adolescents.Methods: Patients of PHF operated in our institute, from January 2008 to January 2016, were reviewed retrospectively. Demographic data, including sex, age at the time of surgery, operated side, and hardware choice, were collected from the hospital database. Preoperative radiographs were reviewed and classified according to Neer-Horwitz classification. Shoulder function was evaluated during 12th month follow-up using rating scale of the American shoulder and elbow surgeons (ASES). Complications, including infection, malunion, nonunion, stiffness of the shoulder joint, and failure of fixation were also recorded.Results: Thirty-five patients, including 23 males and 12 females, were included in the EF group, whereas 40 patients, including 25 males and 15 females, were included in the KW group (P = 0.867). The average age of patients in the EF group was 13.3 ± 1.7 years, and that of KW was 13.6 ± 1.8 years (P = 0.409). Patients in both groups were followed-up for at least 12 months. The operative time in the EF group (42.4 ± 11.2, min) was significantly shorter than those in the KW group (54 ± 13.6, min), P < 0.001. The frequency of fluoroscopy in the EF group (12 ± 2.4) was significantly less than those in the KW group (17 ± 2.8), P < 0.001. The rate of open reduction was significantly higher in KW (35%) group than those in the EF group (0%), P < 0.001. There was no nonunion, malunion cases in both groups.Conclusion: External fixator is superior to Kirschner wire in the treatment of proximal humeral fractures in adolescents with shorter operative time, lower rate of ORIF and comparable clinical outcomes.

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Outcomes of 188 Proximal Humeral Fractures Treated with a Dedicated External Fixator with Follow-up Ranging from 2 to 12 Years

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.18.00734 ◽

2019 ◽

Vol 101 (18) ◽

pp. 1654-1661

Author(s):

Davide Blonna ◽

Marco Assom ◽

Enrico Bellato ◽

Gabriele Pisanu ◽

Valentina Greco ◽

...

Keyword(s):

External Fixator ◽

Proximal Humeral Fractures ◽

Humeral Fractures

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Functional outcome following external fixator (JESS) application for proximal humeral fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164158 ◽

2016 ◽

Vol 2 (4) ◽

pp. 303

Author(s):

Om P. Gupta ◽

Arun Vashisht ◽

Avinash Rastogi ◽

Naman Gupta ◽

Utkarsh Shahi ◽

...

Keyword(s):

Soft Tissue ◽

External Fixator ◽

Scoring System ◽

Young Patients ◽

High Energy ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Average Score ◽

Soft Tissue Dissection ◽

Tissue Dissection

Background: Proximal humeral fractures account for 5% of all fractures. Observed frequently in older osteoporotic patients but found in young patients with high-energy trauma.About 80% of these fractures are undisplaced or minimally displaced. Non-operative method requiring immobilization of shoulder often leads to a stiff shoulder, whereas surgical procedures such as plating need excessive soft tissue dissection. It was overcome in this study by less soft tissue dissection by use of external fixator application and early mobilization.Methods: Total of 18 patients mean age 40.5 years, predominantly male (16/18) treated with external fixator - JESS (Joshi’s external immobilization system) for Neer’s two, three and four part proximal humeral fractures. Vehicular accidents were the most common mode of injury followed by fall. There were 8 cases each of Neer's two and three part fractures. Shoulder mobilization started within a week as postoperativelyas pain allowed. Patients followed up at 3, 6, 12 and 18 weeks for pain, function, range of motion and anatomy with check X-ray. After radiological union at 8-10 weeks JESS was removed. Cases were evaluated for functional result by constant scoring system.Results: Average score on constant scoring system was 72 after a mean follow-up of 6 months. All fractures united in mean duration of 9.33 weeks. The complications included shoulder stiffness in one case and pin tract infection in two cases.Conclusions: Early shoulder mobilization a prerequisite for good results can be achieved without compromising fracture union. Less soft tissue dissection required and significant cost effective.

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