Functional outcome of different treatment modalities of proximal humerus fracture (3 part and 4 part)

Abstract

Introduction: Proximal humerus fracture is the most common fracture of humerus consisting 45% of all humerus fracture and second most common fracture in upper extremity. Diagnosis and proper management of proximal humerus fracture is important as the shoulder joint needs a high demanding function for daily activities. Various treatment options available for proximal humerus fracture from conservative management, K wire fixation, ORIF and plating, hemiarthroplasty to Reverse Shoulder arthroplasty.Aims and Objective: Our study aimed to evaluate the one year follow up results of different treatment modalities in a perspective series of proximal humerus fracture and study complication, if any involved with these modalities and to find out the basis of selecting the mode of treatment of proximal humerus fracture to bring out the best functional outcome.Materials and Method: 40 patients with displaced proximal humerus fracture (3 part and 4 part) treated between September 2018 to August 2019 were included in this study. Out of 40 patients in our study 32 patients have 3 part and 8 patients have 4 part fracture. 33 patients (3 part-27, 4 part-6) treated with PHILOS plating. 3 patients (All 3 part) treated with K wire fixation. 2 patients (All 3 part) treated conservatively. 2 patients (All 4 part) treated by Reverse Shoulder Arthroplasty. The functional outcome has been assessed by Constant-Murley shoulder scoring system.Results: Out of 40 cases 10(25%) patients had excellent result, 21(52.5%) good, 8(20%) moderate and 1 (2.5%) patient show poor outcome. There are few complications in our study-Malunion (3 patients), nonunion (2 patients), Joint stiffness (1 patient), Instability (1 patient), Heterotropic Ossification (1 patient), AVN of humeral head (2 patients).Conclusion: From this study we found that PHILOS is an effective treatment for 3 part fracture and for 4 part fracture Reverse Shoulder Arthroplasty is appears to be better option.