Abstract
Background: Proximal humeral fractures are among common types of fractures and remain a challenging issue for surgical management. This study aimed to assess the clinical outcomes and complication rates of three- vs. four-part proximal humeral fractures, treated with internal fixation using the Philos® plate.Material and Methods: In this cohort study, a total of 30 consecutive patients with three-part or four-part proximal humeral fractures based on the Neer classification were included. Surgical treatment was performed with open reduction and internal fixation using the Philos® plate. The constant score was evaluated 6 months later in follow-up. The P<0.05 was considered significant.Results: Four-part fractures were mainly caused by trauma from above, while insults of opposite direction were responsible for more than half of 3 part fractures (P=0.01). Open fractures were only observed in patients with a four-part fracture (P=0.018). No significant differences were noticed regarding gender, cause, and side of the fracture.The presence of other fractures, fracture of the implant, reduction loss, avascular necrosis (AVN) of humerus head, rotator cuff injury, and revision surgery were significantly higher in patients with four-part fractures.The mean constant score was 81.40±11.61 and 65.09±16.09 for three-part and four-part fractures, respectively (P=0.006).Conclusion: Open reduction and internal fixation with Philos® plate yield acceptable results in both types of fractures, however, the prognosis of this intervention is poorer four-part fractures.
Highlights
Proximal humeral fractures account for circa 4% of all types of fractures and 26% of fractures of the humeral head [1]
Proximal humeral fractures are among common types of fractures and remain a challenging issue for surgical management
Surgical treatment was performed with open reduction and internal fixation using the Philos® plate
Summary
Proximal humeral fractures account for circa 4% of all types of fractures and 26% of fractures of the humeral head [1]. Proximal humeral head fractures are widely considered to be osteoporosis-associated affecting the active elderly as a result of minimal trauma [3]. As a result, these fractures have a substantial negative impact on the quality of life and independence of patients, as well as financial burden on health care systems [4]. Various surgical techniques have been proposed for fixation of comminuted and displaced proximal humeral fractures with the aim of proper restoration of a painless shoulder fulfilling patient’s functional demands. These procedures pose difficult management problems and are not free of adverse events. Conclusion: Open reduction and internal fixation with Philos® plate yield acceptable results in both types of fractures, the prognosis of this intervention is poorer four-part fractures
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