Functional Outcome of Displaced Fractures of the Proximal Humerus managed surgically: A Prospective study

Srinivasan, A (2007) Functional Outcome of Displaced Fractures of the Proximal Humerus managed surgically: A Prospective study. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Fractures of Proximal Humerus are challenging for diagnosis and treatment. They are not uncommon, accounting for 4 to 5% of all fractures. 80-85% of these fractures are minimally displaced or undisplaced and are effectively treated symptomatically with immobilisation followed by early motion. Proximal Humerus Fractures are the third most frequent fracture in elderly patients after hip fracture and Colles fracture10. It is important to recognise these fractures early. Results and Treatment of the most severely displaced Fractures of the Proximal Humerus have not been consistently satisfactory when treated with non-operative measures. If neglected they may result in pain, stiffness, arthritis, loss of muscle power and function. Fractures of Proximal Humerus have gained more attention recently. Diagnosis has been facilitated with adaptation of 3-right angled trauma series X-rays supplemented with CT or MRI. With more standard use of Neer’s 4-part Classification system for fracture and fracture dislocation, a protocol for management and comparison of long term outcome of similar injuries has been made possible. There have been improvements in fixation techniques and in the understanding of the role of prosthetic replacement, to maximise anatomic restoration and minimising immobilisation time, during which stiffness develops. AIM OF THE STUDY: Prospective study of Functional outcome of displaced fractures of the Proximal Humerus managed surgically at the Department of Orthopaedics and Traumatology, Govt. Royapettah Hospital, Royapettah, Chennai between May 2004 and September 2006. MATERIALS AND METHODS: This prospective study is an analysis of functional outcome of 20 cases of surgically managed displaced Proximal Humeral Fractures, undertaken at Department of Orthopaedics and Traumatology, Government Royapettah Hospital, Royapettah, Chennai. From may 2004 to september 2006. Of the 20 patients, 12(60%) were females and 8(40%) were males. The age of the patients ranged from 16-70 years. The mean age of the patients was 44 years. RESULTS: The patients were followed up at regular intervals (ie) every month during the first 3 months and every 3 months thereafter. The minimum follow-up period was 6 months and maximum follow-up period was 24 months. The mean follow-up period in this study was 12.2 months. The results were evaluated during follow-up by taking into consideration the following factors: 1) Pain, 2) Range of motion, 3) Strength, 4) Stability, 5) Function, 6) Roentgenographic documentation of fracture healing, 7) Anatomic restoration. Constant Score: Constant and Murley’s score was used to assess the functional outcome of these patients. The results were graded by using Neer 100 units Rating System. This Rating system consists of 35 units for PAIN, 30 units for FUNCTION, 25 units for RANGE OF MOTION, 10 units for ANATOMY. CONCLUSION: Displaced proximal humeral fractures when treated surgically produce less pain, less stiffness and greater ROM. • Earlier the surgery better are the results. • In severely comminuted fractures where anatomy cannot be restored without extensive soft tissue dissection, fixation with K wires and screws gave better functional results. • Results are better with fractures than with fracture dislocations. • Results are best when operative method results in stable fixation that allows early passive mobilization. • Functional outcome of 2 part fractures is better than 3 part and 4 part fractures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional Outcome ; Displaced Fractures ; Proximal Humerus managed surgically ; Prospective study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 17:46
Last Modified: 17 Sep 2017 14:17

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