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 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 Outcome analysis of patients with proximal humerus fractures treated with locking plates

2017 ◽  
Vol 3 (3) ◽  
pp. 401
Author(s):  
Ritesh Kumar ◽  
S. Natarajan ◽  
Sanjeev Kumar ◽  
R. Kalanithi
Keyword(s):  
Surgical Technique ◽  
Functional Outcome ◽  
Proximal Humerus ◽  
Constant Score ◽  
High Energy ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Proximal Humerus Fractures ◽  
Locking Plates ◽  
Humerus Fractures

<p class="abstract"><strong>Background:</strong> Fracture of proximal humerus incidence has been reported to be 73 cases per 100,000 individuals per year. There are different methods of treatment of proximal humeral fractures. The aim of our study is to analyse the functional outcome of proximal humerus fractures treated with proximal humerus locking plates and to analyse the possible benefits and complications of the procedure<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> This is a retrospective study of 34 patients with proximal humeral fractures treated with ORIF using Proximal humeral locking plates from October 2010 to November 2012 at Saifee Hospital, Mumbai. The cases are evaluated as regards to functional outcome using constant score, fracture healing clinically, radiologically and complications if any and reason for them.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our study shows that proximal humerus fractures are now increasingly seen in younger population with good bone stock following high energy trauma. In elderly it was low energy trauma. The average time of radiological fracture union in our study was 10 weeks (8-16 weeks). The mean constant score at final follow up was 66.7 (35-90). A total of 17 patients (51%) had excellent or good results, but in 9 (27%) the outcome was poor. Eight (23%) complications were noted resulting in poor functional outcome<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. A reproducible standard surgical technique is absolutely necessary for improved patient outcome.  Most of the complications in our study were related to the surgical technique. The precise surgical technique, stable fracture fixation and restoration of correct neck shaft angle are absolutely necessary for improved outcome<span lang="EN-IN">.</span></p>

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 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 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 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

BIOMECHANICAL COMPARISON OF THE ROLE OF INLAY GRAFT IN PROXIMAL HUMERUS FRACTURE FIXED WITH CONVENTIONAL PLATE AND LOCKING PLATE

2013 ◽  
Vol 13 (04) ◽  
pp. 1350055 ◽  
Author(s):  
CHENG-HUNG LEE ◽  
KUI-CHOU HUANG ◽  
CHIH-KUN HSIAO ◽  
SUNG CHENG ◽  
YAU-CHIA LIU ◽  
...  
Keyword(s):  
Locking Plate ◽  
Proximal Humerus ◽  
Varus Deformity ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Locking Plates ◽  
Medial Support ◽  
Maximal Load ◽  
Conventional Plate

With a varus deformity, repairs of proximal humeral fractures frequently fail after screws pull out due to lack of medial support. Indirect intramedullary grafts have been used to prevent such complications. A biomechanical study was performed to investigate the role of an intramedullary bone peg (strut) in fractures fixed with conventional and locking plates. Twenty artificial proximal humerus specimens were divided into four groups. Group 1 specimens were fixed with convention plates and group 2 specimens were fixed with the addition of a bone peg. Groups 3 and 4 specimens were fixed using locking plate and additional bone peg, respectively. All specimens were tested with a static loading test, and the axial stiffness and maximal load were recorded. Locking plates with inlay graft were the most rigid of the four groups. When an intramedullary graft was introduced, the maximal load increased by more than 200%, whether conventional or locking plates were used. The maximal load of a conventional plate with inlay graft was more than twice of that of the locking plate only. Indirect medial support acts as an anti-bending device, reducing the tension on the plate. It also decreases varus deformity and loosening of screws. Locking plate stabilize the plate-bone interface. Locking plate with indirect medial support is thus recommended for patients withsevere osteoporotic or medial comminuted proximal humeral fractures.

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