Abstract
Background: With an incidence of 50% of humerus fractures, proximal humerus fractures (PHFs) can significantly impact one’s quality of life. Moreover, management of highly comminuted or displaced PHFs poses a significant challenge amongst elderly population due to poor bone quality. Prosthetic replacement of humeral head or its stabilization using external plates is a commonly employed intervention for treating three- and four-part PHFs. Thus, these two methods were compared in this study to identify a preferable intervention.Methods: Patients were randomly divided into two groups to receive proximal humerus internal locking system (PHILOS®, Synthes, Switzerland) plating and Neer’s hemiarthroplasty. The deltopectoral approach was deployed as the surgical method. Their surgical outcome was assessed from functional range of motion (ROM) and Constant-Murley scores at regular intervals of three, six, twelve, and twenty-four weeks.Results: Twenty patients were divided into two groups who received PHILOS® plating and Neer’s hemiarthroplasty, averaged 67.2 years and 72.8 years. The ROM pertaining to flexion, extension, abduction, internal rotation, and external rotation for individuals with PHILOS® plating was 20%, 12.5%, 14.7%, 11.5%, and 18.5% higher than those who received Neer’s hemiarthroplasty. Moreover, the Murley score was also 8.7 units higher for individuals with PHILOS® plating.Conclusions: Prognosis following PHILOS® plate osteosynthesis had a better overall outcome than hemiarthroplasty with Neer’s prosthesis. Although hemiarthroplasty yielded a consistent functional outcome, PHILOS® plate osteosynthesis tends to restore a greater ROM. Thus, PHILOS® plating is recommended as the suitable method to manage three- and four-part PHF for people above fifty-five years of age.
Highlights
Proximal humerus fracture (PHF) is the third most common fracture amongst older age (>65 years) and accounts for 4%-5% of all fracture types [1,2,3]
This study aims to assess the surgical outcome of two interventions viz osteosynthesis using Proximal Humerus Internal Locking System (PHILOS)® plate and primary hemiarthroplasty using Neer’s prosthesis
A prospective observational study was conducted to identify a suitable intervention for the management of PHF amongst the elderly population by evaluating post-operative functional outcomes between patients who received PHILOS® plate osteosynthesis and primary hemiarthroplasty using NEER’s prostheses
Summary
Proximal humerus fracture (PHF) is the third most common fracture amongst older age (>65 years) and accounts for 4%-5% of all fracture types [1,2,3]. Even low-velocity injuries like a simple fall in the elderly population can cause PHF; its incidence increases to 80% with age [3]. Amongst the elderly population, existing osteoporotic condition or contact against adjacent glenoid and acromion or the pull of intrinsic (rotator cuff) or extrinsic muscles (pectoralis major) during a fall can contribute to PHF. Still, factors such as osteoporotic bone quality, the fragile soft tissue surrounding the bone, and age-related co-morbidities hinder the management of this kind of fracture [4,5]. These two methods were compared in this study to identify a preferable intervention
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