Prospective study on the outcome analysis of internal fixation of proximal humerus fractures

Anand Kumar, R (2011) Prospective study on the outcome analysis of internal fixation of proximal humerus fractures. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Proximal humerus fractures constitute 4-5% of all fractures and they account for 45% of all humeral fractures. When considering adults over the age of 40 years, this increases to 76%. These fractures have a dual age distribution occuring either in young people following high energy trauma or in those older than 50 years with low velocity injuries like simple fall. Most proximal humerus fractures are either nondisplaced or minimally displaced and can be treated nonsurgically. AIM: to evaluate and analyse the functional outcome of Proximal humerus fractures treated by internal Fixation in the Institute of Orthopaedics and Traumatology , Madras Medical College over a period of two and half years from June 2008 to October 2010. MATERIALS AND METHODS: This study was conducted at Institute of Orthopaedics and Traumatology, Govt General Hospital, Madras Medical College, Chennai. This study is a prospective study from JUNE 2008 to OCTOBER 2010 with a sample size of 29 cases. Informed consent was obtained from each patient, and ethical clearance was obtained from institutional ethical committee. Twenty nine patients were randomly selected from among the admissions to the Orthopaedic ward in the Institute of Orthopaedics and Traumatology, Government General Hospital, Chennai and recruited into the study prospectively based on the following criteria. Inclusion Criteria – 1. Proximal 3rd displaced humeral fractures (NEER classification) which needs to be internally fixed. 2. Patients who give consent to be included in the study. 3. Patients with skeletal maturity. Exclusion Criteria – 1. Skeletal immaturity with open physis, 2. Pathological fractures, 3. Undisplaced fractures, 4. Medically unfit for surgery, 5. Unwilling for surgery. Demographic data (age, gender and profession), mechanism of injury, severity of the injury (NEER classification), associated injuries, initial management and time to definitive treatment were recorded. RESULTS: A total of 29 patients were operated , 18 patients with locking compression plate ,6 patients with AO T buttress plate , 3 patients with screws alone and one patient with k wires alone. Out of the 25 patients followed up, 5 patients had excellent scores, 4 had good scores , 10 had moderate scores and 6 had poor outcome scores. Mean constant score is 63.44 (range 18-86 points). Mean constant score for Neer two part fracture was 74.88 (range 64 – 86), for Neer three parts fracture was 55.9 (range 18 – 86) and for Neer four parts fracture was 58.83 (range 41 – 75). Twenty three out of twenty five patients went in for union at around six weeks follow up (88%) , except those complicated by screw pull out and fixation failure. CONCLUSION: Although the follow-up time in our study was relatively short and it was not a randomized controlled study, the results are comparable with other published studies. Accurate anatomical reduction appears to be more important than the implant used, to achieve a good final functional result, and this factor is independent from the implant design and procedure selected. The options as to the surgical approach or the type of implant used depend on the pattern of the fracture, the quality of the bone encountered, the patient’s goals and the surgeon’s familiarity with the techniques. The learning curve with the implants chosen certainly also plays a role. An adequate surgical technique will minimise complications and an aggressive rehabilitation regime will ensure the best possible result. In general, 2- and 3-part fractures can be treated with open reduction and internal fixation (a plate with screws is the choice). Four-part fractures in the younger, active patient also can be treated successfully with open reduction and internal fixation.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prospective study ; outcome analysis ; internal fixation ; proximal humerus fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 03:04
Last Modified: 14 Sep 2017 03:04

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