Functional Outcome Analysis of Prosthetic Replacement of Communited, Displaced Proximal Humerus Fractures in Elderly Individuals

Muthu Vignesh, A (2020) Functional Outcome Analysis of Prosthetic Replacement of Communited, Displaced Proximal Humerus Fractures in Elderly Individuals. Masters thesis, Madurai Medical College, Madurai.


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BACKGROUND: Proximal humeral fractures, defined as fractures occurring at or proximal to the surgical neck of the humerus and affect 2.4% of women over the age of 75 years. In patients above the age of 65 years proximal humeral fractures are the second most frequent upper extremity fracture, and the third most common nonvertebral osteoporotic fracture after proximal femur and distal radius fractures, accounting for > 10% of fractures in this patient population. Females are more commonly affected than males and it has been demonstrated that 15% to 30% of fractures occur in males. The incidence has been shown to increase exponentially at a rate of over 40% every 5 years at age 40 in females and age 60 in males. Approximately half of all proximal humeral fractures occur at home with the majority occurring as a consequence of falls on level ground. In individuals 60 years or older, over 90% of proximal humeral fractures result from a fall from a standing height. The proximal humerus can fracture as a consequence of three main loading modes: compressive loading of the glenoid onto the humeral head, bending forces at the surgical neck, and tension forces of the rotator cuff at the greater and lesser tuberosities. AIM OF THE STUDY: To analyse the functional outcome of prosthetic replacement of communited, displaced proximal humerus fractures in elderly individuals. OBJECTIVES: 1. To analyse the clinical, radiological & functional outcome of elderly patients treated with prosthetic replacement of comminuted proximal humerus fracture. 2. To assess the range of movements, functional outcome at 3months, 6 months, 12 months and 24 months. MATERIAL AND METHODS: 20 cases of neer’s 3 part 4 part proximal humerus fractures & fracture dislocation shoulder in elderly patients admitted at Govt Rajaji Hospital, Madurai will be taken up for study after obtaining consent.hemiarthroplasty of shoulder is done for the patients and functional outcome is analysed by constatnt score at each follow up. RESULTS: In this study the percentage of male injured was 45% and that of female was 55% and the mean age was 64.45. The most common mode of injury was accidental fall for female patients which showed that the proximal humerus fracture are common following trivial trauma in the osteoporotic women. Most cases fall under 6th decade and are mostly female. The main complication observed was post op infection in 2 patients which contributes 10% of patients and paraesthesia in 5%. The operated patients are mostly of type 4 fractures contributing 60% of total patients.The side injury are common on right side making 55%. The qualitative analysisi of constant score based on gender was good in 91.70% in female as compared to 62.50% in male and its very good in 25% male as compared to nil in female. The above mentioned very good outcome is seen in 3 part fracture.On comparing the constatnt score in 3 and 4 part it was significantly good in 3 part at 3 months follow up with p value of 0.028 but become insignificant at final 2 year follow up. There was no significant difference in operating within a week and after a week. There was a statistically significant difference in median Pre OP and repeated measures of post OP CS score, χ2(5) = 99.105, p = 0.001. Though the qualitative interpretation of CS in ordinal scale shows significant improvement in pair wise comparison between pre OP, 1 month, 3 months and with 6 months follow up (p=0.001**) but there was no significant difference between 6 months, one year and two years follow (p > 0.0033). The value of constant score showed quantitative increase in all follow up. But ordinal interpretation of CS showed prognostic improvement till 6th month follow up and remains stable from 6th months to 2 years follow up as good interpretation of CS (71-85). CONCLUSION: With increasing geriatrics population having poor bone quality and with rising incidence of proximal humerus fractures, replacement of the shattered humeral head provides early functional recovery and also ensures that the aged people lead a quality and independent life post operatively.

Item Type: Thesis (Masters)
Additional Information: 221712104
Uncontrolled Keywords: Hemiarthroplasty, Humerus, Displaced Proximal Humerus Fractures, Elderly Individuals.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 13 Feb 2021 14:54
Last Modified: 13 Feb 2021 14:54

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