Functional outcome of comminuted and segmental fractures of shaft of humerus treated surgically with the gold standard management plate osteosynthesis: A Prospective study

Kaliraj, G (2010) Functional outcome of comminuted and segmental fractures of shaft of humerus treated surgically with the gold standard management plate osteosynthesis: A Prospective study. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Fractures of humeral diaphysis constitute 3% of all bone injuries. The anatomy, fracture configuration and the region involved influences the treatment option. The rich muscle sleeve surrounding the bone and good vascularity provided by them helps in fracture healing. The wide range of movements of shoulder accomodates for a minimal degree of angulation and shortening. The limb does not take part in weight bearing or ambulation which allows some shortening to acceptable but not the rotational deformity. AIM OF STUDY: Prospective study on functional outcome of Comminuted and segmental fractures of shaft of Humerus treated surgically with the gold standard Management plate osteosynthesisat Government Royapettah Hospital, Chennai between January 2008 to June 2009. MATERIALS AND METHODS: This prospective study is an analysis of functional outcome of 20 cases of surgically managed severely comminuted and segmental fractures of shaft of humerus undertaken at Department of Orthopaedics and Traumatology Government Royapetth Hospital Chennai from January 2008 to June 2009. Among the 20 patients 14were males and 6 patients were females. The age of the patients ranged from 20 years to 60 years. The mode of injury was fall at ground level in 5(25%) patients, road traffic accidents in 13(65%) patients, fall from height in 2(10%) patients. Sixteen patients presented to us within a week after injury and 8 patients had previous treatment either in the form of native splinting, massage or POP cast. A meticulous clinical examination was made in all patients with care to look for any associated injuries. 5 patients had associated injuries which were concomitantly treated. Standard anteroposterior and lateral radiographs of the affected humerus were taken in all patients that include the shoulder and elbow joints in each view. Further views ordered depending on the clinical examination and any abnormalities noticed on initial films. RESULTS: The patients were followed up at regular intervals i.e., every month during the first 3 months and every 3 months thereafter.The minimum follow up period was 6 months and the maximum follow up period was 15 months. The mean follow up period in this study was 9 months. 1. Pain, 2. Range of motion, 3. Strength, 4. Stability, 5. Function, 6. Reontgenographic documentation of fracture healing, 7. Anatomical restoration. Constant score: Constant and Murley’s score was used to asses the functional outcome of these patients. The results were graded by using Neer 100 units rating systems. The rating system consisting of 35 units for PAIN, 30 units for FUNCTION, 25 units for RANGE OF MOTION, 10 units for ANATOMY. 13(65%) patients said that they had no pain and 4(20%) patients had only mild pain, 3(15%) patents had pain after unusual activity. No patients had disabling pain. CONCLUSION: Fractures of shaft of humerus is best treated by plate osteosynthesis even in situations like severely comminuted fractures and segmental fractures. The functional outcome is best with plate osteosynthesis. In severly communited fractures and segmental fractures where restoration needs soft tissue dissection, plate osteosynthesis can be done by. MIPPO technique, locking compression plate, Less invasing stabilization system(LISS). In osteo porotic fractures, plate Osteosynthesis can be done using LCP. To conclude plate Osteosynthesis gives good function outcomes segmental and comminuted fractures, and equally good results comparing to other modalities besides less morbidity.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional outcome of comminuted and segmental fractures ; shaft of humerus ; treatment ; surgically ; gold standard management plate osteosynthesis ; Prospective study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 18:13
Last Modified: 17 Sep 2017 16:52
URI: http://repository-tnmgrmu.ac.in/id/eprint/2978

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