A study of outcomes of proximal humerus fractures treated with plate osteosynthesis

Abstract

Introduction: Proximal humerus fractures are the third most common non vertebral osteoporotic fracture after proximal femur and colles fractures, accounting for >10% of fractures, above the age of 65 years and has a 3:1 female predominance. Many different techniques have been used to treat displaced or comminuted proximal humerus fractures. However, many of these constructs are less stable than open reduction and internal fixation (ORIF) with locking plates. Locked plating has been shown to be an advancement over previous fixation techniques in that it allows for rigid fixation with low rates of fixation loss. Objective: The objective of this study was to 1) study outcomes of proximal humerus fractures treated with plate osteosynthesis (PHILOS plate or PHLP plate). 2) To establish the role of proximal humerus plate osteosynthesis in treatment of complex proximal humeral fractures. 3) To establish the role of proximal humeral locking plates in early mobilization. Materials and Methods: 44 patients with proximal humerus fractures were reviewed between from September 2011 to April 2016. They were randomized and treated with either proximal humerus interlocking system (PHILOS) or the proximal humerus locking plate after taking clearance from the ethical committee. Closed & compound fractures, 2/3/4 part in adults’ more than 18 years, Fit and willing for surgery were included in the study. Patients with pathological fractures, distal neuro vascular deficit, immunosuppressive therapy, infection, poor general condition were excluded from study. Patients were followed up at 2 weeks, 6 weeks, 3 months and 6 months. Radiographs were taken to check position of plate and fracture healing. Patients were evaluated with NEER’s shoulder scoring system at 3 & 6 months after radiological confirmation of fracture healing. Results: Out of 44 patients with proximal humerus fractures, 26 were treated with PHILOS and 18 with PHLP plate. The average time to union was 13.04 weeks in PHILOS and that for PHLP plate being 15.48 weeks. Rotator cuff was tied in 11 patients out of 44. Bone graft substitute was used only in 3 patients out of 44. The Neer’s score in this study has consistently improved over time. At the end of 6 weeks it was 61.5 which then rose to 73 at end of 3 months. The average Neer’s score in our study at end of final follow up at 6 weeks was 80.5 which falls into the satisfactory group. We observed 10 patients (22.7%) with complications which resulted in poor functional outcomes. The main complication observed in this study was shoulder stiffness seen in 8 patients. Conclusion: A reproducible standard surgical outcome is key to better functional outcome in patients with proximal humerus fractures. Rotator cuff tying leads to a better functional outcome as compared to those without rotator cuff repair. Also there has been an observed better outcome in more complex fractures. Hence this surgical technique can be advocated for routine surgical management of proximal humerus fractures.