Abstract
Background: Proximal Humeral fractures are defined as fractures occurring at or proximal to surgical neck of Humerus1. Various methods are used for treating such conditions with mixed results. Closed reduction & percutaneous pinning with JESS augmentation with interconnecting double frames have been described for such fractures with satisfactory results. We aim to modify the same by mounting the JESS in a single frame with biplanar configuration review our results. Material and Methods: Total 15 patients with proximal humeral fractures were treated from 2016 to 2017 by fixation with JESS & K-wires. There were 10 (62.5%) males and 5 (37.5%) females, with a mean age of 57.5 years. Road traffic accident (RTA) was the most common mode of injury in patients less than 60 years old (4 out of 7), while fall on the ground was the most common cause in fractures in elderly patients (age>60 years, i.e. 6 out of 8). Displaced (more than 45° of angulation or >1cm of displacement) 2 and 3 part fractures and patients of age >20 years were included in the study. The fixator was removed when there was clinical (subsidence of pain) and radiological signs of union (bridging callus in 3 out of 4 cortices). Shoulder function was assessed using Constant scoring system. Result: 100 % union seen with duration ranging from 6weeks to 8 weeks followed by JESS removal. According to Constant score 3 cases (20%) showed excellent result, 9 cases (60%) showed good result, 2 cases (13.3%) showed fair result & 1 case(6.7%) showed poor result which may be due to noncompliance in physiotherapy & early pin loosening. Conclusion: External fixation with JESS & K-wires is an alternative cost effective option to treat Neer’s 2 & 3 part fractures, enables early mobilization & achieves safe healing with less soft tissue dissection. Keywords: Proximal humerus fractures, External fixator, JESS.
Highlights
Proximal Humeral fractures are defined as fractures occurring at or proximal to surgical neck of Humerus[1]
They account for 4% of all fractures & approximately onehalf of all Humeral fractures2. 80% of the proximal Humeral fractures are undisplaced or minimally displaced & usually treated conservatively but rest 20% of fractures are displaced & require operative fixation[345]
Closed reduction and percutaneous pinning has a low risk of neurovascular complications or interference with glanohumeral joint motion but it is a less stable construct & there is often loss of reduction[11]
Summary
Proximal Humeral fractures are defined as fractures occurring at or proximal to surgical neck of Humerus[1]. There is no definite consensus on the type of surgical fixation that should be used Various methods such as closed reduction & percutaneous pinning, tension band wiring, intramedullary nailing, plate fixation & hemiarthroplasty have all demonstrated mixed results. Joshi’s External Stabilization System with K (Kirschner)-wires provide satisfactory fracture stability once closed reduction is achieved, provides superior functional result & early mobilization. Material and Methods: Total 15 patients with proximal humeral fractures were treated from 2016 to 2017 by fixation with JESS & K-wires.There were 10 (62.5%) males and 5 (37.5%) females, with a mean age of 57.5 years. Conclusion: External fixation with JESS & K-wires is an alternative cost effective option to treat Neer’s 2 & 3 part fractures, enables early mobilization & achieves safe healing with less soft tissue dissection
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