Functional outcome of surgical management of proximal humerus fracture treated by various modalities

Abstract

Introduction: Fractures of the proximal humerus constitutes 7% of all fractures and approximately onehalf of all humerus fractures. In the elderly population above 65 years of age, these are second most frequent upper extremity fracture and third most common non vertebral osteoporotic fractures. Management of proximal humerus fracture with various treatment modalities has always been a topic of debate and draws much controversy and confusion with it because of the complexity of these injuries with fracture displacements. Moreover, even good anatomical results achieved with operative fixation may lead to poor results unless supported by a meticulous postoperative rehabilitation. Aim: To assess and compare the functional outcome with different modalities of the fixations in proximal humerus fractures. Method: A prospective study comprising of 23 patients with proximal humerus fractures classified through Neer's classification. Modalities of treatment employed included (1) Closed reduction and Percutaneous K-wire fixation (2) Open reduction and Internal fixation with Locking Compression Plate (PHILOS) (3) Closed reduction and Internal fixation with Intramedullary Nail and (4) Shoulder Hemiarthroplasty. Functional outcome was evaluated using Constant Murley score and American Shoulder and Elbow Surgeons Shoulder Score (ASES) based on pain, function, strength and range of motion. Result: Higher incidence of these fracture was seen in (61%) females as compared to males. Most of the fractures (43%) occurred in the age group 50-60 years. Fall from a standing height was the most common mode of trauma in elderly patients while in younger patients, these fractures were mostly a result of RTA or sporting injuries. Two part and three part fractures were found to be commoner of all fractures constituting 39% and 34.8% respectively. Functional outcome evaluated using Constant Murley Score shown Excellent outcome in 13% cases, Good outcome in 34.8% cases and Fair outcome in 39.1% cases while in 13% patients, outcome was poor. The unsatisfactory results in our series was seen mostly in elderly patients who were reluctant or not compatible for rigorous rehabilitation program. Conclusion:Fractures of the proximal humerus have varied patterns and are complex injuries to manage. Reconstruction of the articular surface with restoration of the anatomy, achieving stable fixation, with minimal soft tissues damage and preservation of blood supply remains the key for attainment of optimal functional outcome.