Comparison of open reduction internal fixation with proximal humerus interlocking system and close reduction and pinning with K-wire in proximal humeral fracture

Abstract

Introduction: Fracture of the proximal humerus represents the second most common fracture in upper extremity. The indications of surgery continue to expand due to improvement in internal fixation techniques. Aim: This study aimed to compare the result of open reduction internal fixation with proximal humerus interlocking system and close reduction and pinning with K-wire in these fractures. Materials and Methods: This study included 48 cases which were divided into two groups by randomized controlled trial type of study design, 24 patients (Group A) were operated with proximal humerus internal locking system (PHILOS) and 24 patients (Group B) with percutaneous K-wire fixation. All the 48 patients were followed up for a mean duration of 11 months. Final evaluation was done according to Neer's (1970) criteria. Results: All fractures united with an average of 10.34 weeks. Union time between the groups was statistically insignificant. In Group A, 83.33% of cases had favorable results against 50.0% of Group B and difference was significant. In Group A, mean Neer's score was 86.0 and in Group B it was 77.7 and difference was significant. In Group A, mean Neer's score for range of motion (ROM) was 20.75 and in Group B it was 17.25 and difference was significant. Ten complications (subacromial impingement-1, screw perforation-1, infection-1, malunion-2, stiff shoulder-3, and pain in shoulder-2) were seen in six patients (25%) treated with PHILOS and 17 complications (K-wire migration-2, infection-2, malunion-4, stiff shoulder-6, and pain in shoulder-3) were seen in 10 patients (41.1%) fixed with K-wire. Conclusion: In patients of 2-part and 3-part displaced proximal humerus fractures, results are almost equivocal. However, mean Neer's score for ROM was significantly more in patients treated with PHILOS. In 4-part fracture and patients of age >50 years, results of PHILOS are significantly better than K-wire.