scholarly journals Study of functional outcome of surgical management of proximal humerus fracture by various modalities: a two-year study at a tertiary care hospital

2020 ◽  
Vol 6 (2) ◽  
pp. 242
Author(s):  
Addanki Vijayanand ◽  
Narreddy Jayasomeswar
Keyword(s):  
Functional Outcome ◽  
Surgical Management ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Tertiary Care ◽  
Humerus Fracture ◽  
Significant Heterogeneity ◽  
Care Hospital ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

<p class="abstract"><strong>Background:</strong> Proximal humerus fractures account for nearly 6-10% and are on a rise. The management of this is controversial and is challenging task. There is a significant heterogeneity among the studies in describing the best surgical procedure in proximal humerus fracture. The objective of the study is to assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures.</p><p class="abstract"><strong>Methods:</strong> A two-year prospective study was conducted after getting ethical approval at Narayana Medical College on cases admitted with proximal humerus fractures as per the inclusion criteria based on Neer’s classification. Radiological evaluation was done, and surgery was performed. Postoperative follow-up was done at 1st, 4th, 8th and 14th week and outcome were evaluated for each case based on Neer’s shoulder score.<strong></strong></p><p class="abstract"><strong>Results:</strong> 30 cases were included with a mean age of 48.2 years. Road traffic injury was common cause of fracture. Of the total 30 cases, 23 cases had excellent results, 4 cases were satisfactory, 2 cases were unsatisfactory, and one case had a failure. The mean scores observed on Neer’s score was pain (33.5 units), Function (23.5 units), range of motion (16.55 units) and anatomy (6.9 units).</p><p class="abstract"><strong>Conclusions:</strong> Clinical evaluation, obtaining proper radiological views, age of the patient and activity holds the key for realistic approach and surgical management of complex humerus fractures. Proper patient selection and thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery and good functional outcome.</p>

scholarly journals Use of proximal humerus internal locking system plate in proximal humerus fractures and its relation with the functional outcome

2019 ◽  
Vol 6 (1) ◽  
pp. 90
Author(s):  
Prasanna Kumar G. S. ◽  
Akash V. Mane ◽  
Amit Kumar Yadav ◽  
Abhishek Harsoor ◽  
Jithsen Manna
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Proximal Humerus ◽  
Constant Score ◽  
Tertiary Care ◽  
Care Hospital ◽  
Proximal Humerus Fractures ◽  
Excellent Outcome ◽  
Good Outcome ◽  
Humerus Fractures

<p class="abstract"><strong>Background:</strong> Proximal humerus fractures are the fractures occurs at or proximal to the surgical neck of the humerus, which accounts for 7% of all fractures and 80% of all humeral fractures. Now a days most of these fractures are managed with internal fixation because of better availability of anatomical plates. The aim was to assess the functional outcome and complications of proximal humerus fractures treated with proximal humerus internal locking system (PHILOS).</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 30 patients with two, three, and four parts proximal humerus fractures treated with proximal humerus internal locking sysyem from 2016 to 2018 with 25 to 80 years of age in a tertiary care hospital. Functional outcome is assessed by using constant murley shoulder scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> Functional outcome as per constant score, 10 patients (33%) got excellent outcome, 06 patients (20%) got very good outcome, 07 patients got (23%) good outcome, 05 patients got (17%) fair outcome and 02 patients got (07%) poor outcome. Complications observed were superficial infections, implant failure and axillary nerve neuropraxia.</p><p class="abstract"><strong>Conclusions:</strong> Open reduction and internal fixation by using PHILOS is the ideal method in treating displaced proximal humerus fractures mainly in two and three part proximal humerus fractures which provides stable fixation and less complications.</p>

scholarly journals Outcomes of Percutaneous Pinning Technique in the Management of Two-Part and Three-Part Proximal Humerus Fracture in Adults

2020 ◽  
Vol 19 (2) ◽  
pp. 129-139
Author(s):  
Abdulkadr Muhammed Sleman Alany ◽  
◽  
Hasan Mazin Shekheel Mercalose ◽  
Thaqaf Alauldeen Fadhil Al-Bayati
Keyword(s):  
Functional Outcome ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Trauma Surgery ◽  
Case Series ◽  
Humerus Fracture ◽  
Proximal Humerus Fractures ◽  
Percutaneous Pinning ◽  
Neck Shaft Angle ◽  
Humerus Fractures

Background: Proximal humerus fractures represent 4-5% of over-all fractures. In patients above 40 years of age, it accounts for 75% of all humerus fractures. Fractures of the proximal end of the humerus oftentimes represent a management dilemma with the multiple surgical options available to deal with them. Objective: To evaluate the functional and radiographic outcomes of the percutaneous pinning techniques in the management of two-part and three-part proximal humerus fracture. Patients and Methods: A case series of 25 patients, functional outcome was determined by ASES and Constant scores and multiple radiographic views were taken to assess the fracture union, mal-union, and the presence of avascular necrosis. Results: ASES score of the whole group was 87.27 while the mean Constant score was 79.04. Only 16% of the entire group developed varus malunion (defined by Neck-Shaft-Angle <=120degrees). Moreover, 16% of the whole group developed OA of the glenohumeral joint. Conclusion: This study supports that the percutaneous close reduction and pinning technique is an effective and reliable surgical technique in the management of closed two-part and three-part proximal humerus fractures in adults. Appropriate preoperative planning is important to achieve a successful surgical result, and regular postoperative follow-up and rehabilitation are essential to get an optimum functional outcome. Keywords: Proximal humerus fracture, percutaneous pinning, upper extremity surgery, trauma surgery, Clinical outcomes, Percutaneous fracture fixation

scholarly journals Skin Entrapment in an Un-displaced Proximal Humerus Fracture Treated with Closed Reduction; A Case Report

2016 ◽  
Vol 10 (1) ◽  
pp. 120-124
Author(s):  
Michael Hughes ◽  
Antonio Frasquet-Garcia ◽  
Mobeen Ismail ◽  
Mohammad Waseem
Keyword(s):  
Closed Reduction ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Rare Complication ◽  
Low Energy ◽  
Humerus Fracture ◽  
Proximal Humerus Fractures ◽  
The United Kingdom ◽  
Literature Searches ◽  
Humerus Fractures

Background: Proximal humerus fractures are a common presentation to Orthopaedic services in the United Kingdom, and the incidence is increasing. Proximal humerus fractures are usually associated with low energy trauma in elderly patients. There is a sub-set of younger patients who suffer low energy fractures due to underlying osteopenia, commonly associated with alcohol excess. Skin puckering or dimpling has been described as a very rare complication of proximal humerus fracture. Based on the few previously published reports of this complication, skin entrapment in proximal humerus fracture is usually predictive of failure of closed reduction, and need for open surgery. Methods: Literature searches were carried out for relevant keywords. Articles were then critically appraised before being included in the literature review. Results: The Authors were only able to identify three previous reports of this rare complication. Conclusion: The authors describe a rare case of skin interposition in an un-displaced proximal humerus fracture, outline a technique for closed reduction, and review the current literature surrounding this rare complication.

scholarly journals Functional outcome following surgical management of proximal humerus fracture in elderly

2017 ◽  
Vol 3 (4f) ◽  
pp. 386-389
Author(s):  
Dr. Vanka Ashok Kumar ◽  
Dr. Raghuveer Adiga ◽  
Dr. Abhishek S Bhasme ◽  
Dr. Ram Prasad Rai ◽  
Dr. Terence D souza
Keyword(s):  
Functional Outcome ◽  
Surgical Management ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Humerus Fracture

scholarly journals A prospective study to analyze the outcome of proximal humerus fracture managed with proximal humerus locking plate

2016 ◽  
Vol 2 (4) ◽  
pp. 215
Author(s):  
Biju R. ◽  
Kumar Babu B.L.S. ◽  
Viswanath Gautham M.
Keyword(s):  
Prospective Study ◽  
Proximal Humerus Fracture ◽  
Locking Plate ◽  
Proximal Humerus ◽  
High Energy ◽  
Humerus Fracture ◽  
Common Mechanism ◽  
Minor Trauma ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

<p><strong>Background:</strong> The incidence of proximal humerus fractures has increased in last few years due to changes in life style and increase in road traffic accidents. Hence, the challenge of the modern day treatment was to get accurate reductions anatomically, fast healing and early restoration of function. Proximal humerus locking plate revolutionized the treatment without compromising fracture union. The present study aimed to evaluate the functional and radiological outcome of proximal humerus fracture managed with proximal humerus locking plate.</p><p><strong>Methods:</strong> This prospective study was conducted at Narayana Medical College Hospital for a period of two years from December 2014 to June 2016. 30 cases of proximal humerus fractures in adults after meeting inclusion criteria were participated and treated surgically with proximal humerus locking plate technique. Consent form was taken from all the patients. The final functional outcome was assessed by radiography and DASH scoring system.</p><p><strong>Results:</strong> Proximal humerus fractures were found to have high incidence in the 40 to 45 age group which had 37% of the study population. Males predominated over females in our study. Ratio of males to female was 2:1. Right sided fractures are more in the present study in both the sexes. The most common mechanism of injury was fall on the outstretched hand from a standing height or less with minor trauma seen in 34% of patients. High energy trauma was more frequently involved in younger patients (30%). According to Neer’s classification two part fractures constituted the most common type 16 (54%) in this study. The collected data was analyzed using SPSS software version 23.0. A ‘p’ value less than 0.05 was considered significant.</p><strong>Conclusions:</strong> The proximal humerus locking plate method for proximal humerus fracture emerges to be safe, effective, reliable fixation with minimal complications.

scholarly journals Cost-effectiveness of Open Reduction and Internal Fixation Compared With Hemiarthroplasty in the Management of Complex Proximal Humerus Fractures

2018 ◽  
Vol 2 ◽  
pp. 247154921775145
Author(s):  
Robert J Thorsness ◽  
James C Iannuzzi ◽  
Edward J Shields ◽  
Katia Noyes ◽  
Ilya Voloshin
Keyword(s):  
Cost Effectiveness ◽  
Internal Fixation ◽  
Open Reduction ◽  
Retrospective Cohort ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Cost Effective ◽  
Humerus Fracture ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

Objectives To determine if open reduction and internal fixation (ORIF) is more cost-effective than hemiarthroplasty (HA) in the management of proximal humerus fracture. Design Retrospective cohort study with cost-effectiveness analysis. Setting Tertiary referral center in Rochester, NY. Patients/participants The records of 459 consecutive patients in whom a proximal humerus fracture was treated surgically at our institution between the years 2002 and 2012 were studied retrospectively. We identified 30 consecutive patients with a mean follow-up of 60.3 months (13.6–134.5 months) of which 15 patients underwent primary ORIF and another 15 underwent primary HA for the management of head-splitting fracture or fracture-dislocation of the proximal humerus. Intervention HA or ORIF for the management of proximal humerus fracture. Main outcome measurements SF-36 scores were converted to utility weights, and a cost-effectiveness model was designed to evaluated ORIF and HA. Results Given the baseline assumptions, ORIF was slightly more costly but also more effective (0.75 quality-adjusted life years [QALY] vs 0.67 QALY) than HA. The incremental cost-effectiveness ratio (ICER) was $5319/QALY for ORIF compared to HA, which is less than the cost-effectiveness standard utilized based on a willingness to pay of $50,000/QALY. Conclusions Compared to HA, ORIF is the more cost-effective approach for the surgical management of complex proximal humerus fractures. These data are limited by patient selection which would impact the relative utility scores. These results suggest that ORIF should be considered the preferable surgical approach given payer and patient perspectives. Level of Evidence: This is a Level III retrospective, cohort therapeutic study.

scholarly journals Primary Hemiarthroplasty Following Severe Proximal Humerus Fracture Dislocations with Irretrievable Humeral Head in Young Patients

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Lim Chia Hua ◽  
Khairul Nizam Siron
Keyword(s):  
Humeral Head ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Young Patients ◽  
Humerus Fracture ◽  
Fracture Dislocation ◽  
Proximal Humerus Fractures ◽  
Range Of Movement ◽  
Humerus Fractures ◽  
Good Range

Neer first popularised the use of primary hemiarthroplasty to treat complex proximal humerus fractures, especially when the humeral head is nonviable or not reconstructable with internal fixations, and with younger patients. A 16-year-old boy had a motor vehicle accident and sustained a closed right proximal humerus fracture dislocation without neurovascular injury. Intraoperatively, due to difficulty retrieving the humeral head which dislocated and positioned behind the clavicle, hemiarthroplasty was done to avoid injuring the brachial plexus, vessels and lung. Mr Y, a 34-year-old man similarly sustained closed left proximal humerus fracture dislocation with an irretrievable head. He too underwent hemiarthroplasty. Both patients were followed up for a year with no pain and fairly good range of movement and muscle power. In complex proximal humerus fractures, there is still debate regarding primary hemiarthroplasty. There are risks of secondary displacement of fracture fragments and head necrosis after internal fixation. Neer and Cofield reported over 90% patients had relief of pain and 66% patients had free range of movement post hemiarthroplasty. Other authors described primary malposition and subsequent migration or deficient osseous integration as a complication after prosthesis. In a thirteen-year observational cohort study of 163 patients with hemiarthroplasty, the overall rate of prosthetic survival was 96.9% at one year, 95.3% at five years, and 93.9% at ten years. Of the factors that were assessed, the age is most important due to factors such as degenerative changes in the rotator cuff, osteoporosis, and motivation to achieve a good range of motion. Successful treatment of acute proximal humerus fractures with prosthetic replacement is challenging to orthopaedic surgeons as it requires proper patient evaluation, good surgical technique, especially in soft-tissue tensioning and stability, and meticulous rehabilitation. In young patients with good bone quality and irretrievable head, hemiarthroplasty is a choice.

scholarly journals MANAGEMENT AND OUTCOME ANALYSIS OF PROXIMAL HUMERUS FRACTURES BY PHILOS - A PROSPECTIVE STUDY

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Mukka Naveen ◽  
D. Narsimlu
Keyword(s):  
Prospective Study ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Humerus Fracture ◽  
Proximal Humerus Fractures ◽  
Early Recovery ◽  
Systemic Complications ◽  
Post Surgery ◽  
Humerus Fractures ◽  
A Prospective Study

Introduction: Proximal humerus fracture is considered as one of the commonest fractures in clinical practice. Most of these fractures occur as a result of osteoporosis. Proximal humerus fractures are often nondisplaced or minimally displaced fractures with two parts, which can be managed conservatively. Surgical interventions include closed reduction and percutaneous pinning (CRPP). It also involves trans-osseous suture fixation, Open Reduction Internal Fixation (ORIF) with either conventional or Proximal Humerus Interlocking Osteosynthesis System (PHILOS) or hemiarthroplasty. Good clinical outcomes have been achieved by the PHILOS as they stabilize the proximal humeral fractures with steady fixation in osteoporotic bone and assisted aged patients in early functional exercises which resulted in early recovery.  Aim: To analyse the functional results and complications associated with management of proximal humerus fractures treated with PHILOS. Materials and Methods: This is a prospective study conducted at Department of Orthopaedics, Prathima Institute Of Medical Sciences, Nagunur, Karimnagar, from July 2017 to January 2019.  58 patients were taken into study with two-part, three-part, four-part fracture of the proximal humerus in adults >18 years of age. In all patients PHILOS plating was done and surgical events and surgical difficulties faced, post-surgery local or systemic complications, time needed for fracture union and time taken to return to pre-fracture activity were documented. They were followed up till there were signs of union on radiographs or for at least a period of 1 year. Results: The results were assessed with Constant Murley Score at 6 months post-surgery and Visual Analogue Scale at 6 weekly intervals. The mean Constant score for two-part fractures was 88.1, for Three-part 82.5, for Four-part 72.7. The patients with two-part and three-part fractures had a significantly better VAS than patients with four-part fractures till 18 months of surgery. After 18 months the VAS was similar for all 3 groups. 6.9% developed shoulder stiffness, 2 patients from four-part fracture group developed Varus angulation. Conclusion: we conclude that the PHILOS is safe, effective and provides stable fixation for  proximal humerus fractures and in patients with indigent bone quality.  Keywords:  PHILOS, Proximal Humerus Fracture

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