scholarly journals Clinico-radiological and functional outcome of surgical management of displaced two part, three part and four part proximal humeral fractures in adults treated by PHILOS plate in a tertiary care hospital in North India: a prospective study of 30 patients

2021 ◽  
Vol 9 (10) ◽  
pp. 3006
Author(s):  
Pankaj Spolia ◽  
Abdul Ghani ◽  
Sakib Arfee
Keyword(s):  
Prospective Study ◽  
Functional Outcome ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Rigid Fixation ◽  
Care Hospital ◽  
Excellent Outcome ◽  
Good Functional Outcome ◽  
Philos Plate

Background: Treatment of proximal humeral fractures is challenging. In the past, the fractures were treated conservatively which compromised the functional results. PHILOS plate provides a good functional outcome with context to the early joint mobilization and rigid fixation of the fracture.Methods: This was the prospective study of 30 patients aged 20 to 60 years (mean age 48.4 years) with proximal humeral fractures including two part, three part and four part fractures based on Neer’s classification, treated by open reduction internal fixation with PHILOS plating. Functional outcome was assessed using Constant-Murley Score.Results: The final outcome was observed at 6 months follow up. The results were comparable with the existing literature. The Mean Constant Score at 6 month follow up was 79.4, range (38 to 92). Out of 30, (n = 12, 40%) had excellent outcome, (n = 9, 30%) had good functional outcome, 6 (20%) had moderate outcome, 3 (10 %) had poor outcome. Out of 30 patients, one patient with four part fracture had a lowest CS of 38. Complications were observed in 5, (16.7%) patients. Varus malunion in one patient, avascular necrosis in one patient, stiffness in one patient.Conclusions: PHILOS plate gives stable fixation, enables early range of motion and minimizes complications with good functional outcome if done with expert hands.

scholarly journals Clinico-radiological and functional outcome of Neer’s 2 part, 3 part and 4 part proximal humeral fractures in elderly treated by conservative management in a tertiary care centre of North India

2021 ◽  
Author(s):  
Pankaj Spolia ◽  
Abdul Ghani
Keyword(s):  
Elderly Patients ◽  
Prospective Study ◽  
Functional Outcome ◽  
Constant Score ◽  
Tertiary Care ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
North India ◽  
Excellent Outcome

<p><strong>Background:</strong> Treatment of proximal humeral fractures is challenging. Despite a rising incidence in proximal humeral fractures, there is still no evidence for the best treatment option, especially for the elderly patients. The aim of this prospective study was to evaluate the radiological in terms of union and functional outcome in terms of pain, range of motion of conservatively managed proximal humeral fractures in elderly patients.</p><p><strong>Methods:</strong> This was an observational prospective study of 35 patients aged above 65 years with proximal humeral fractures including 2 part, 3 part and 4 part based on Neer’s classification, treated by conservative method. Functional outcome was assessed by using Constant score at follow up of 1 year.</p><p><strong>Results: </strong>Out of 35 patients, 21(60%) were female and 14 (40%) were male with mean age of 76.8 (range 65 to 91years). On the basis of Neer’s classification, majority of patients (15, 42.8%) had 3 part fracture. Radiological union was achieved within 13 to 24 weeks, with an average of 18.4 weeks. Out of 35, 5 (14.3%) had<strong> </strong>excellent outcome, 8 (22.8%) had good functional outcome, 16 (45.7%) had moderate outcome, 6 (17.14%) had poor outcome. The results were comparable with the existing literature.</p><p><strong>Conclusion: </strong>In the present study, our data shows that the proximal humeral fractures can be effectively managed conservatively in the elderly patients. Two part fractures have best functional outcome and four part fractures have highest rate of complications.</p>

scholarly journals Radiological correlation with functional outcome in displaced proximal humerus fractures treated with locking plates: a prospective study of 35 cases

2018 ◽  
Vol 4 (3) ◽  
pp. 471
Author(s):  
Neetin Pralhad Mahajan ◽  
Nikhil Dilip Palange ◽  
Eknath D. Pawar ◽  
Hitesh Jivrajbhai Mangukiya ◽  
Ujwal Suryabhan Ramteke ◽  
...  
Keyword(s):  
Prospective Study ◽  
Functional Outcome ◽  
Proximal Humerus ◽  
External Rotation ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Locking Plates ◽  
Range Of Movement ◽  
Maximum Improvement

<p class="abstract"><strong>Background:</strong> The objective of this prospective study is to investigate the relationship between the functional outcome and the radiographic results of two-, three- and four part proximal humeral fractures treated with open reduction and fixation with PHILOS locking plate.</p><p class="abstract"><strong>Methods:</strong> 35 patients (30 males and 5 females) with displaced proximal humerus fracture were treated with PHILOS plating and studied prospectively. According to Neer’s classification there were 16 two part fracture (45%), 15 three part fracture (42%) and 4 four part fracture (13%). The healing of fracture, head shaft angle (HSA) and complications were evaluated radiologically with plain radiographs whereas the functional outcome was assessed by the Shoulder Pain and Disability Index (SPADI) at 6 weeks, 3 months, 6 months and 1 year after surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study, patients treated with locking plates had mean forward flexion of 123°, abduction of 124°, mean external rotation of 30° and internal rotation 53° at 1 year follow-up. Maximum improvement in range of movement occurred between interval of 12 weeks to 24 weeks due to complete fracture union occurred approximately up to 12 weeks. The mean SPADI score at end of 1 year were 10.22, 10.38 and 10.20 for two, three and four part fractures respectively. Average postoperative and follow-up HSA's were 134.1±4.4 and 132.5±1.2 degrees, respectively. Varus progression was more prominent in patients with postoperative HSA &lt;130 (p&lt;0.001). Complications included impingement in 1 case, joint penetration by screw in 1 case, failure of fixation in 1 case and infection in 1 case.</p><p class="abstract"><strong>Conclusions:</strong> Fixed angle locked plate is an extremely useful implant for reconstruction and salvage of proximal humeral fractures. Precise surgical technique, stable fracture fixation and restoration of anatomical reduction are absolutely necessary for improved outcome.</p>

scholarly journals Functional outcome of patients treated with proximal humeral internal locking osteosynthesis plate in proximal humeral fractures

2020 ◽  
Vol 6 (6) ◽  
pp. 1182
Author(s):  
Tigy Thomas Jacob ◽  
Manmatha Nayak
Keyword(s):  
Functional Outcome ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Articular Surface ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Humerus Fracture ◽  
Excellent Outcome ◽  
Osteosynthesis Plate ◽  
Philos Plate

<p class="abstract"><strong>Background:</strong> Displaced or unstable proximal humeral fractures fare poorly with non-operative treatment. These are better treated with surgical intervention in order to prevent minimal displacement of tuberosity or articular surface from compromising the long term articular function. The objective was to assess the functional outcome of patients treated with PHILOS (the proximal humeral internal locking osteosynthesis) plate in proximal humerus fracture.</p><p class="abstract"><strong>Methods:</strong> 42 patients age group range between 20 and 80 years 61.9% are male and 38.1% are female treated with philos plate. Functional outcome measured by using Constant and Murley score.<strong></strong></p><p class="abstract"><strong>Results:</strong> 50% were Neer two part fractures, 35.7%, three part fractures, 14.3%, four part fractures. After 6 month follow up functional outcome assessed by using constant and Murley score. Excellent outcome in 1 (2.4%) good outcome in 13 (31%), fair outcome in 19 (45.2%) and poor outcome in 9 (21.4%) noted.</p><p class="abstract"><strong>Conclusions:</strong> PHILOS plate fixation of proximal humerus fracture is an effective surgical technique in maintaining stability of fractures and there is significant improvement in functional outcome.</p>

scholarly journals Functional outcome evaluation of Neer’s two part and three part proximal humeral fractures treated by percutaneous K-wire fixation in a tertiary care hospital in North India: a prospective study of 21 patients

2021 ◽  
Author(s):  
Pankaj Spolia ◽  
Abdul Ghani
Keyword(s):  
Soft Tissue ◽  
Blood Loss ◽  
Prospective Study ◽  
Functional Outcome ◽  
Tissue Damage ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Wire Fixation ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> The treatment of proximal humeral fractures is controversial. The advantages of percutaneous Kirschner’s wire (K-wire) fixation include preservation of periosteal blood supply, minimal blood loss, less soft tissue damage and shorter hospital stay. The aim of this study was to evaluate the 2 part and 3 part proximal humeral fractures in terms of functional outcome at final follow up.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study of 21 patients aged 20 to 60 years with mean age of 44.2 years including two part and three part proximal humeral fractures based on Neer’s classification, treated by percutaneous K-wire fixation. Functional outcome was assessed by Constant-Murley score at 1 year follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> On the basis of Neer’s classification, 13 patients had 2 part fracture, 8 patients had 3 part fracture. Radiological union was achieved within 7 to 15.2 weeks, with an average of 11.6 weeks. The mean constant score at 1 year follow up was 78.2, range (42 to 96). In the present study, complications were seen in 8 (38.1%) patients. The results were in proximity with the existing literature.</p><p class="abstract"><strong>Conclusions:</strong> Percutaneous fixation is minimally invasive technique with preservation of periosteal blood supply, minimal blood loss, less soft tissue damage, surgery can be done under brachial plexus block, less chances of avascular necrosis, shorter hospital stay, no hardware in situ, thus no hardware symptoms, leaves no surgical scar and lowers the rate of complications.</p><p class="abstract"> </p>

Functional outcome following one-part proximal humeral fractures: A prospective study

2008 ◽  
Vol 17 (2) ◽  
pp. 216-219 ◽  
Author(s):  
Nirmal C. Tejwani ◽  
Frank Liporace ◽  
Michael Walsh ◽  
Monet A. France ◽  
Joseph D. Zuckerman ◽  
...  
Keyword(s):  
Prospective Study ◽  
Functional Outcome ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
A Prospective Study

scholarly journals Does time to surgery affect patient-reported outcome in proximal humeral fractures? A subanalysis of the PROFHER randomized clinical trial

2020 ◽  
Vol 102-B (1) ◽  
pp. 33-41 ◽  
Author(s):  
John G. Norman ◽  
Stephen Brealey ◽  
Ada Keding ◽  
David Torgerson ◽  
Amar Rangan
Keyword(s):  
United Kingdom ◽  
Functional Outcome ◽  
The United States ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Altman Plot ◽  
Bland Altman Plot ◽  
Time To Surgery ◽  
The United Kingdom

Aims The aim of this study was to explore whether time to surgery affects functional outcome in displaced proximal humeral fractures Methods A total of 250 patients presenting within three weeks of sustaining a displaced proximal humeral fracture involving the surgical neck were recruited at 32 acute NHS hospitals in the United Kingdom between September 2008 and April 2011. Of the 125 participants, 109 received surgery (fracture fixation or humeral head replacement) as per randomization. Data were included for 101 and 67 participants at six-month and five-year follow-up, respectively. Oxford Shoulder Scores (OSS) collected at six, 12, and 24 months and at three, four, and five years following randomization was plotted against time to surgery. Long-term recovery was explored by plotting six-month scores against five-year scores and agreement was illustrated with a Bland-Altman plot. Results The mean time from initial trauma to surgery was 10.5 days (1 to 33). Earlier surgical intervention did not improve OSS throughout follow-up, nor when stratified by participant age (< 65 years vs ≥ 65 years) and fracture severity (one- and two-part vs three- and four-part fractures). Participants managed later than reported international averages (three days in the United States and Germany, eight days in the United Kingdom) did not have worse outcomes. At five-year follow-up, 50 participants (76%) had the same or improved OSS compared with six months (six-month mean OSS 35.8 (SD 10.0); five-year mean OSS 40.1 (SD 9.1); r = 0.613). A Bland-Altman plot demonstrated a positive mean difference (3.3 OSS points (SD 7.92)) with wide 95% limits of agreement (-12.2 and 18.8 points). Conclusion Timing of surgery did not affect OSS at any stage of follow-up, irrespective of age or fracture type. Most participants had maximum functional outcome at six months that was maintained at five years. These findings may help guide providers of trauma services on surgical prioritization. Cite this article: Bone Joint J 2020;102-B(1):33–41

scholarly journals Functional outcome in displaced proximal humeral fractures in adults treated by proximal humeral locking plates

2019 ◽  
Vol 6 (1) ◽  
pp. 178
Author(s):  
N. V. Narasimha Rao ◽  
K. Ravi Kanth ◽  
Rama Priya Yasam ◽  
T. Jaya Chandra
Keyword(s):  
Functional Outcome ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Shoulder Function ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Medical College ◽  
Score Improvement ◽  
Average Improvement

<p class="abstract"><strong>Background:</strong> The management of proximal humerus fractures (PHF) is a challenging task to any surgeon. Study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system in fixation of displaced proximal humeral fractures.</p><p class="abstract"><strong>Methods:</strong> Study was conducted in the Department of Orthopedics, GSL Medical College. Informed written consent was taken from the study participants. All skeletally mature patients aged &gt;18 years, presenting with displaced PHF according to Neer two, three and four part fracture were included in the study. Either deltopectoral or deltoid splitting approach was used for surgery, post-operative rehabilitation was started on day one.<strong></strong></p><p class="abstract"><strong>Results:</strong> Twenty-five patients with PHF were enrolled in the study; five-holed proximal humerus locking plate (PHLP) was used for 18 patients, eight-holed PHLP for 05 and three-holed, ten-holed PHLP for 01 for one each. The Constant-Murley score was significantly improved (p=0.000) over each successive follow-up period with the average improvement of around 19 scores between 1<sup>st</sup> and 2<sup>nd</sup> follow-up and around 15 score improvement between 2<sup>nd</sup> and 3<sup>rd</sup> follow-up.</p><p class="abstract"><strong>Conclusions:</strong> The proximal humeral locking plate is an adequate device for the fixation of displaced two-part, three-part and four-part PHF. Patient can regain good shoulder function, resume normal activities much earlier.</p>

scholarly journals MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly

2021 ◽  
Vol 12 ◽  
pp. 215145932110439
Author(s):  
Guoyun Bu ◽  
Weitang Sun ◽  
Jian’an Li ◽  
Tao Yang ◽  
Mingxin Li ◽  
...  
Keyword(s):  
Blood Loss ◽  
Elderly Patients ◽  
Operation Time ◽  
The Elderly ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Plate Group ◽  
Philos Plate ◽  
Fracture Types

Background Proximal humeral fractures (PHFs) account for 4–5% of all fractures in the elderly. There is still a controversy among the treatments in the displaced PHFs. Our aim was to explore the clinical outcome of PHFs with the treatment of MultiLoc nail or Philos plate in the elderly patients. Methods A total of 82 sustained elderly patients with PHFs were finally recruited between Dec 2016 and Dec 2017. 34 patients were treated with MultiLoc nail and 48 patients were treated with Philos plate. The demographics, fracture types, blood loss, operation time, union time, postoperative complications, visual analog scores (VASs), Constant scores, American Shoulder and Elbow Scores (ASESs), and neck-shaft-angle (NSA) between the two groups were compared. Results No differences were observed in the demographics, fracture types, VAS, Constant scores, and ASES scores between the two groups at final follow-up. Compared with the plate group, the blood loss, operation time, and union time were significantly lower in the nail group (all P < .05). The rate of general complications was 54.17% in the plate group, which was higher than that in the nail group (26.47%, P = .01). Three patients experienced reoperation in the plate group (3/48; 6.25%), but none in the nail group. Although there were no significant differences in intraoperative NSA between the two groups, the NSA at final follow-up in the nail group was much higher than the plate group (137.55 ± 5.53°vs 134.47 ± 5.92°, P = .02). Conclusions Multiloc intramedullary nail showed the similar effectiveness of final VAS, final Constant scores, and ASES scores in PHFs treatment with Philos plate. However, MultiLoc nail is superior to Philos plate in blood loss, operation time, complications, reoperation rate, and the change of NSA.

Sign in / Sign up

Export Citation Format

Share Document