Functional outcome of hemiarthroplasty for proximal humeral fractures - short term prospective outcome analysis

Niranjanan, M Raghavn (2013) Functional outcome of hemiarthroplasty for proximal humeral fractures - short term prospective outcome analysis. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Proximal humeral fractures constitute 45% of all humeral fractures and up to 5% of the total fracture incidence. The incidence of proximal humerus fractures rise to nearly 76% above the age of 45 years. It is the third commonest cause of fractures after hip and distal radius fractures in people above 65 years of age. More than 85% of these fractures are only minimally displaced. Such fractures may be treated conservatively. A low or moderate energy fall in an old person whose bone quality is poor is the commonest mode of developing a proximal humeral fracture. Displaced fractures of the proximal humerus continue to pose challenges to the orthopaedic surgeon. Poor bone quality, weak surrounding soft tissues, associated co-morbidities complicate the management of these injuries. Prosthetic Hemi-arthroplasty is the standard of care for markedly displaced fractures, including 4 part fractures, fracture dislocations, head splitting fractures, fractures with impression defects involving more than 45% of the humeral head Some patients with 3 part fractures may also need to be considered for hemiarthroplasty because of advancing age, severe -comminution and poor bone stock. AIM: To analyse the short term functional outcome of 3 part and 4 part proximal humerus fractures treated with hemiarthroplasty at the Institute of Orthopaedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai between May 2010 and December 2012. MATERIALS AND METHODS: This study was designed to determine the short term functional outcome of fractures of the proximal humerus treated with Hemiarthroplasty. From May 2010 to December 2012, 20 patients with 3 and 4 part proximal humerus fractures presenting to the Institute of Orthopaedics and Traumatology, Madras Medical College and Rajiv Gandhi Govt Gen Hospital were treated with hemiarthroplasty. The patient selection criteria are as follows: Inclusion criteria: 1. Age more than 45 years, 2. Neer’s classification 3 part and 4 part fractures, 3. Closed fractures, 4. Fracture dislocation. Exclusion criteria: 1. Age less than 45 years, 2. Compound fractures, 3. Associated Humeral shaft fractures, 4. Associated glenoid fractures. 5. Uncooperative patient for post operative rehabilitation Patients of both sexes satisfying the above inclusion criteria and willing to be enrolled in the study after obtaining informed written consent were included in the study. RESULTS: 1. The incidence of complex fracture patterns of the proximal humerus has a slight female preponderance (11:9). 2. The dominant hand is involved 1.5 times more often. (R>L) 3. Fall from floor level is the commonest mode of injury which suggests an osteoporotic undercurrent. 4. One patient had a fracture of both sides but had a gap of 1 year between the 2 injuries. Both injuries were sustained by falls inside the house. 5. 6 patients reported to the hospital within 24 hours of injury (30%). However 3 patients presented later than 3 months. The mean was approximately 1.5 months, suggesting patients try native treatment before reporting to the hospital. (40%) 6. The patients when classified according to the fracture pattern were distributed evenly. 7. Time between hospital admission and surgery ranged from 12 hours to 30 days, with a mean of 9.9 days. This reflected the co morbidities present and the delay in bringing the patient to anaesthetic fitness. 8. 2 patients had associated fractures (10%) and one of them required addition surgical management. 9. All patients were placed under General anaesthesia, with patients being in supine position and were approached through a deltopectoral approach. 10. Cephalic Vein was lateralized in 19 and medialized in 1 patient. CONCLUSION: Hemiarthroplasty provides an efficient option for treatment of complex fractures of the proximal humerus. There is excellent pain relief and moderate return of function in elderly patients with minimal complications. However a study with larger number of patients with long term follow up is needed before the conclusions can be generalized to the population.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional outcome ; hemiarthroplasty ; proximal humeral fractures ; short term prospective outcome analysis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 03:48
Last Modified: 14 Sep 2017 03:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/3140

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