Evaluation of Proximal Humerus Fractures and Its Non-Surgical Management (original) (raw)
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Our clinical results in the management of proximal humeral fractures
Annals of Medical Research, 2020
The aim of this study was to evaluate the clinical, radiological and functional results of patients treated with different methods in our clinic for proximal humerus fracture. Material and Methods: A total of 106 patients with a diagnosis of proximal humerus fracture, who were scheduled for treatment, received management and followed up periodically after discharge were included. Patient files, X-RAY radiographs in the PACS system, surgical notes and outpatient epicrisis were used. Functional results were evaluated according to Constant shoulder score at the last visit. Results: The mean age of the patients was 53.6 years (17-94). The mean follow-up period was 11.3 months (6-40 months). 55 (51.9%) had Type II, 35 (33%) had Type III and 16 (15.1%) had Type IV proximal end humeral fractures. As a result of the evaluation performed at the last follow-up of the patients, Constant-Murley's total score was 64.50 out of 100 (31-88). Score distribution according to Neer classification of patients; A Constant-Murley score median with a Neer Type II fracture was 74.00 (36-88), a Constant-Murley Score median with a Neer Type III fracture was 61.00 (31-78), and a Constant-Murley score median with a Neer Type IV fracture was 44.50 (33-70). Conclusion: When the fracture type and functional outcome of the patients were compared, functional outcome decreased as the fracture type increased. Young patients had better functional results than older patients.
Indian Journal of Applied Research, 2011
INTRODUCTION: Proximal humerus fractures are very common fractures occurring in the skeleton. They account for approximately 4-5% of the fracture attendance at the hospital. The preferred treatment depends on various factors including the patient's age, bone quality, the patterns of fracture and the patients' expectations and physical demands. In this study, we have studied the results of different modalities of operative treatment, their advantages & disadvantages, complications & outcomes in terms of functional and radiological results.
A Study on Outcome of Surgical Management of Proximal Humerus Fractures
Fractures of the proximal humerus represent approximately 4% of all fractures and 26% of humerus fractures. The study is to Study the occurrence, mechanism of injury and displacement of various types of fracture according to Neer's. Results were evaluated by the use of Neer's shoulder score based on pain, function, range of motion and anatomy for each case assessed and recorded. Proximal humeral fractures account for almost 4 to 5% of all fractures. These fractures have a dual age distribution occurring either in young people following high energy trauma or in those older than 50 years with low velocity injuries like simple fall. The incidence of proximal humeral fractures has increased in last few years due to changes in life style and increase in road traffic accidents. The best management in these injuries is still inconclusive. Studies have shown non-operative and operative treatments, both give favorable results, and the confusion remains.
Surgical management of proximal humerus fractures – Assessment of results
IP Innovative Publication Pvt. Ltd, 2017
Introduction: Proximal humeral fracture whether caused by trauma or related to osteoporosis, requires carefully planned individual treatment. The choice of technique and devices depends on quality of bone, soft tissue, age and reliability of patients. However the goal of proximal humerus fracture fixation should be stable reduction, allowing early motion of fracture. Objectives: To analyze fractures of the proximal humerus that were treated either with the proximal humerus internal locking system (PHILOS) locking plate or percutaneous K wire and document their clinical and functional outcome. Materials and Method: The study includes patients with proximal humerus fractures who underwent Open reduction and internal fixation with PHILOS locking plate or Percutaneous K-wire fixation. Functional outcome was evaluated by Constant-Murley score. Patients were followed up at 6 weekly interval until fracture union and at once at 1 yr after the surgery 30 cases were studied, cases were selected randomly for both PHILOS and percutaneous k wire fixation, each 15 cases. Results: 33.34% patients treated with open reduction and internal fixation with PHILOS plating had good to excellent results, 46.6% of patients had fair results and the remaining 20% had poor results. 40% of patients treated with closed reduction and K wire fixation had good to excellent results, 40% of patients had fair results and remaining 20% had poor results. Conclusion: The results of surgical treatment of proximal humerus fractures in both the groups (percutaneous pinning and PHILOS plating) are satisfactory with good functional outcome.
Comprehensive Study of Surgical management of Proximal Humerus fractures in adults-A REVIEW ARTICLE
The majority of proximal humerus fractures are treated nonoperatively with good functional results. Multiple options exist for treating displaced fractures, without a clear advantage of any one method for a given fracture type. Goals include an adequate reduction and stable fixation to initiate early motion and rehabilitation. Decision-making should be based on patient and injury specifics and surgeon's experience. Various types of fixation, including plates, nails, or percutaneous pins, can maintain sufficient stability to promote shoulder mobility and function. Any of these methods will have few complications when undertaken with appropriate patient selection and careful surgical technique.Locked plating may improve fracture stability in some complex patterns and facilitate early rehabilitation. It is possible that some fractures previously treated with hemiarthroplasty may be managed successfully with locking plates. Prospective study to assess the complications, outcomes, and cost effectiveness of nonoperative management compared to various surgical treatment options is warranted.
Study of outcomes of the proximal humerus fractures treated by various modalities
International Journal of Orthopaedics Sciences, 2018
Introduction: The proximal humerus fracture is of great importance when it affects the young and middle age groups of the population as it leads to temporary disability and loss of working hours. Restoration of the function of the limb becomes the primary goal of its treatment. Principle of fixation is reconstruction of the articular surface, including the restoration of the anatomy, stable fixation, with minimal injury to the soft tissues preserving the vascular supply. The present study was conducted to analyze the occurrence, mechanism of injury and displacement of various types of proximal humerus fractures and further evaluate the functional outcome of different modalities of its management.
Proximal humeral fractures: a review of current concepts
The open orthopaedics journal, 2013
The majority of proximal humerus fractures are sustained via low energy falls in the elderly population. These patients can attain an acceptable level of function via non-operative treatment. There is yet to be a clear consensus on treatment options suitable for those that fall outside of this majority group. Open reduction internal fixation, intra medullary nailing and arthroplasty surgery have all been used to varying effects. Good results are achievable if complications such as mal-union, non-union and avascular necrosis can be avoided. This review aims to clarify the options available to the current day trauma surgeon.
IOSR Journals , 2019
Fractures of the proximal humerus are complex injuries with significant morbidity .Although various options of management available including non-operative management are present the choice of treatment depends upon the pattern of the fracture, the quality of the bone encountered, the patient's goals and the surgeon's familiarity with the techniques. The aim of this study was to review the functional, radiographic results and complications of the operative procedure in a series of twenty patients. Over a two year period we treated twenty patients with two part fractures, three part fractures, four part fractures and fracture dislocations. Initial pre operative clinical and radiological assessment was done and appropriate mode of treatment of given depending upon type of fracture according Neer's classification. Follow up of patient was done both clinically and radiologically at 2nd, 6th and 8th weeks and assessed for any complications. Final assessment was done according to Neer's shoulder scoring criteria. Eight patients were treated with Locking Compression Plate, eight patients were treated with K-wires and cancellous screws, three patient were treated by interlocking nail, remaining one underwent hemi-arthroplasty. All fractures united with an average of 17.7 weeks and no patients had signs of malunion, non-union osteonecrosis of the humeral head on the latest follow up radiographs. In the overall results analyzed in our series 70% of the patients had excellent and satisfactory results and 30% had unsatisfactory and failure outcome. There is direct relationship in displaced proximal humeral fractures between fracture severity i.e. displacement and communition, and the eventual results.That is more the initial insult, worse the prognosis. Internal fixation of fractures of proximal end of humerus produced good functional outcome and fewer complications. Rehabilitation is the key to success
Management of Proximal Humeral Fractures
Journal of Hand Therapy, 1994
Fractures of the proximal end of the humerus are one of the more common fragility fractures seen in the elderly; in the younger and active population, they may represent a consequence of high-velocity trauma. The anatomical or the surgical neck may be involved with varying degrees of involvement of the humeral head. The treatment options depend on a variety of factors. This review examines the various fracture types, their treatment options, the associated complications, and the recent developments in the management of this challenging fracture.
A study of different surgical modalities in the management of proximal humerus fractures
International Journal of Orthopaedics Sciences
Background: Proximal humerus fractures are common but debilitating injuries. Numerous factors contribute to post injury functional outcomes; therefore, a large debate exists over appropriate treatment. Optimal treatment for displaced or unstable two, three, and four-part proximal humerus fractures remains controversial. This study is conducted to analyze the results of proximal humerus fractures treated by different modalities of surgical fixation. Materials & Methods: This study was carried out in Malla Reddy Institute of Medical Sciences, from July 2016 to June 2018. Thirty patients of displaced proximal humeral fractures were admitted in this hospital and treated surgically by PHILOS plate, K-wire and hemiarthroplasty. Follow up is done from 4 weeks to 12 months both clinically and radiologically. Results were evaluated by the use of Neer's shoulder score. Results: Most common mode of injury was found to be road traffic accident and the most common type was two part fracture accounting for 12 out of 30 patients (40%).The results were evaluated by Neer's score. The average follow up duration was 11.4 months. Of the thirty patients, 7 (23.3%) had excellent results, 17 (56.7%) had satisfactory results, 4 (13.3%) had unsatisfactory results and 2 (6.67%) were failure. Conclusions: Closed reduction and percutaneous pinning can be used for un-displaced or displaced fractures of the proximal humerus without comminution, in the younger age groups with good bone quality. In older individuals it is good to fix with percutaneous K wires, considering bone density (osteoporosis) and also to reduce the period of surgery. K wire fixation gave excellent results in our patients for the treatment of unstable 2 part proximal humerus fractures. Proximal humerus locking plate (PHILOS) gives reliable fixation for 2-part and 3-part fractures and has good functional outcome. In more complicated fracture patterns of 4-part fractures, its use is associated with poor clinical outcome. Prosthetic replacement should be considered as primary treatment in cases with marked comminution of the humeral head, in fracture-dislocations, and in elderly patients.