Comparative Study of Open Reduction Internal Fixation with Proximal Humerus Interlocking System and Closed Reduction and Pinning with K –Wire in Proximal Humeral Fracture

Abstract

Background: Treatment of proximal humerus fractures may be conservative or operative. Each procedure has some limitations and complications. A major disadvantage of conservative treatment is failure to obtain early mobilization, which results in a high rate of shoulder stiffness and pain and malunion or nonunion is likely with certain fracture types. Objective: To compare functional outcomes and complications after open reduction and internal fixation of proximal humerus fractures (type 2 and 3 Neer classification) by proximal humeral internal locking osteosynthesis system (PHILOS) versus percutaneous fixation with K- wires.Patients and methods: Our study was conducted upon 20 Patients (M=7, F=13) in elderly group with two parts (10 patients) and three parts (10 patients) proximal humerus fractures according to Neer's classification patients was randomized to either (group 1) who were treated by open reduction and internal fixation with PHILOS plate and (group 2) who were treated with percutenous K- wire fixation. Results: The mean follow up UCLA score was 30 points (range from 26 to 34) points in (group 1) and 31 points (range from 27 to 35) points in (group 2), values varied depending upon the fracture type with worst in 3 parts fractures. Conclusion: we obtained satisfactory results in both groups with each procedure having its advantages and short comings. We found that fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasions and soft tissue dissection and PHILO'S plate fixation provided stable fixation with minimal implants problems and enabled early range of motion exercise to achieve acceptable functional results.