A Prospective and Retrospective Analysis of Functional Outcome of Proximal Humeral Fractures Treated with Proximal Humerus Internal Locking Osteosynthesis System.(PHILOS)

Praveen Kumar, A (2015) A Prospective and Retrospective Analysis of Functional Outcome of Proximal Humeral Fractures Treated with Proximal Humerus Internal Locking Osteosynthesis System.(PHILOS). Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Fractures of proximal humerus account for about 4 to 5% of all fractures. It is the third most common fracture after hip fracture and colles fracture in elderly patients. As the technology has advanced, the elderly people no longer need to be denied effective surgical treatment. AIM OF THE STUDY: In this study we have analyzed 20 cases of proximal humeral fractures treated surgically using PHILOS plates admitted at Institute of Orthopaedics & Traumatology, Rajiv Gandhi Govt General Hospital, Madras Medical College, Chennai from June 2012 to September 2014. The aim of the study was to analyze the functional and radiological outcome and to assess the complications of proximal humeral fractures treated using PHILOS plates. MATERIAL AND METHODS: Patients with proximal humerus fractures, who are skeletally mature and age more than 18 years satisfying Neer's criteria for operative displacement i.e. displacement of >1 cm between the major fracture fragments or angulation of the articular surface of >45 degrees and Neer's two, three and four part fractures were included in the study. Patients with open fractures, pathological fractures, with associated neurovascular injury and associated head injury were not included. All patients were evaluated with standard anteroposterior radiographs of the affected shoulder and most of them were further evaluated with Neer's three view trauma X rays. CT Scan and 3D CT were taken if needed. Radiological evaluation of the fractures was done and were classified according to Neer's four part classification system. 12 patients (60%) had two part fractures, 7 (35%) had 3 part fractures and 1(5%) had four part fractures. Fracture dislocations were present in 2 patients. The patients were operated by the standard anterior deltopectoral approach or deltoid splitting approach using PHILOS plates. All the patients were reviewed at two weeks interval, for first three months and later every month. During follow up, patients were clinically evaluated for pain and function. The minimum follow-up period was 3 months and maximum follow up period was 8 months. Radiological evaluation of fracture union was observed by serial x rays. RESULTS AND OBSERVATION: Majority of injured patients were females (60%) and the highest number of patients were in their 5th decade (35%). Free fall at ground level was the most common mode of injury (50%) but one patient had post-epileptic fall causing the fracture. No case with bilateral fractures was reported. Neer's 2 part fracture is the most common type in 60% patients. Greater Tuberosity fractures were the predominant type in 2 part fracture. 4 part fractures accounted for only 5% of patients. Fracture dislocation were present in 2(10%) of patients. Early complications like wound gaping, skin necrosis and deltoid atony were encountered. Late complications like malunion of greater tuberosity and joint stiffness were encountered. Constant and Murle y's score was used to assess the functional outcome of our patients. The average constant score in our study with 20 patients was 82.4. CONCLUSION: Finally we concluded that displaced proximal humeral fractures when treated surgically produce greater range of movements (ROM), less pain and less stiffness. Functional outcome is better with isolated fractures than with fracture dislocations. Functional outcome of 2 part fractures is better than 3 part and 4 part fractures. Radiological outcome assessed by means of quality of reduction and union of fracture in two and three part fractures is better than in four part fractures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Proximal humeral fractures ; PHILOS plates ; Neer's classification ; Constant score.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 25 Sep 2017 01:01
Last Modified: 25 Sep 2017 01:01
URI: http://repository-tnmgrmu.ac.in/id/eprint/3299

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