Proximal Humerus Fractures Managed With Joshi External Stabilizing System

Abstract

Proximal humerus fractures account for 4% to 5% of all fractures. These fractures have been conventionally treated either conservatively in a shoulder immobilizer or by open reduction and internal fixation with a locking plate. Conservative treatment often leads to a stiff shoulder, and operative management requires extensive soft tissue dissection. In this study, we have chosen a middle path for treating proximal humerus fractures in the form of closed reduction and Joshi external stabilizing system (JESS) with early mobilization, thus overcoming the problem of shoulder stiffness associated with conservative management and excessive soft tissue dissection associated with the open procedure. We conducted a study on 25 patients with proximal humerus fractures with Neer types 2 and 3 fractures. The mean age was 49.6 years with a female preponderance of 64%. JESS was applied after closed reduction in all cases. Mobilization was started on days 1 or 2 of surgery. All patients were followed up at 2, 4, 6, and 8 weeks and at 6 months after surgery. All cases were evaluated functionally using the constant shoulder scoring system. In our study, the mean constant shoulder score was 75.7 at 6 months. All fractures united in 6 to 8 weeks. In our study, we had 2 cases of pin-tract infection and 1 case of shoulder stiffness. The JESS fixator is a good modality of treatment for Neer types 2 and 3 proximal humerus fractures, facilitating early mobilization without compromising on fracture stability and union rates.