Locking plate fixation for unstable proximal humerus fracture: A prospective study

Abstract

Background: Unstable fractures of the proximal humerus represent a surgical challenge despite the wide range of treatment options available. The proximal humerus locking plate is a good surgical option in the management of unstable proximal humerus fractures. Aim: The purpose of this study is to determine whether locking plate fixation in the treatment of displaced and unstable proximal humerus fractures leads to a good functional outcome. Settings and Design: Medical school hospital, observational study. Subjects and Methods: Thirty-two patients with unstable proximal humerus fractures treated with proximal humerus locking plate between November 2017 and March 2019 were included in the study. The fractures were classified based on the Neer's classification into two-, three-, and four-part fractures. The minimum follow-up was 1 year. The Constant–Murley scoring system was used for functional assessment. Constant scores for two-, three-, and four-part fractures were determined and compared with respect to the age, gender, handedness, and occupation of the study participants. Statistical Analysis Used: Chi-square test was applied for discrete variables and one-way ANOVA was used to compare between the three fracture types. P ≤ 0.05 was taken as significant. Results: Fourteen patients had two-part fractures, 13 patients had three-part fractures, and 3 patients had four-part fractures. The mean follow-up period was 17.5 months (range: 12–24 months). About 65.6% (n = 21) patients had good result, 31.3% (n = 10) had fair, and 3.1% (n = 1) had poor result. Constant scores for 2-part (84.14 ± 2.98) and 3-part fractures (82.15 ± 3.78) were significantly superior to those of 4-part fractures (72.80 ± 3.63) (P = 0.000 and 0.000, respectively). Difference between 2-part and 3-part fractures was not significant (P = 0.142). There was no significant difference in the functional outcome between patients who were employed and unemployed, right and left handed. Complications include stiffness in 6.3% (n = 2) and infection in 3.1% (n = 1) of cases. Conclusion: Proximal humerus locking plate gives stable fixation for 2-part and 3-part fractures. However, in case of Neer's 4 part-fractures, the functional outcome is relatively poor.