Functional outcome following open reduction and internal fixation of proximal humerus fractures with locking compression plate

Authors

  • Mohamed Nishad M. Department of Orthopedics, Baby Memorial Hospital, Calicut, Kerala
  • Mohamed Shakeeb K. U. Department of Orthopedics, MES Medical College, Perinthalmanna, Malappuram, Kerala
  • Gijo A. J. Department of Orthopedics, MES Medical College, Perinthalmanna, Malappuram, Kerala

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20205465

Keywords:

Proximal humerus fractures, Open reduction, Internal fixation, Locking compression plates, PHILOS, PHLP

Abstract

Background: Proximal humerus fractures (PHFs) are common upper extremity fractures representing break in humerus bone. Incidences of PHFs increased in last few years due to life style changes and increased road accidents. Appropriate management strategy for PHFs is still uncertain. The aim of current study is to assess the functional outcome following open reduction and internal fixation of proximal humerus fractures using locking compression plates.

Methods: Current study is a descriptive investigation conducted on 31 PHFs patients admitted to baby memorial hospital, calicut, between January 2013 to June 2014. Surgical management of PHFs was done by open reduction and internal fixation using locking compression plates and functional outcomes and complications of the employed treatment modality were investigated.

Results: PHFs were observed to be common in 41-60 years age group, with 65% males being affected. Road accidents and domestic falls were observed to be the most common causes of PHFs in younger and elderly populations respectively. Three parts PHFs were observed to be more prevalent, followed by two and four parts fractures. Results of current study revealed that majority of PHFs united by 8-10 weeks duration with 22.58% cases with excellent and 41.93%, 16.12% and 19.35% cases with good, moderate and poor constant and Murley score respectively. Two patients reported post-operative complication of shoulder stiffness, while one patient each reported plate impingement, varus maluion, infection and varus malunion with intraarticular screw cut-out.  

Conclusions: Locking compression plates (PHILOS/PHLP) is an efficient treatment modality for proximal humerus fractures allowing early mobilization and good functional outcome.

References

Kanatli U, Bölükbaşi S, Ekin A, Ozkan M, Simşek A. Anatomy, biomechanics, and pathophysiology of instability of the glenohumeral joint. Acta Orthop Traumatol Turc. 2005;39 (Suppl 1):4-13.

Boileau P, Walch G. The three-dimensional geometry of the proximal humerus. J Bone Joint Surg Br. 1997;79-B(5):857-65.

Prescher A. Anatomical basics, variations, and degenerative changes of the shoulder joint and shoulder girdle. Eur J Radiol. 2000;35(2):88-102.

Rockwood CA. The Shoulder. 4th ed. Philadelphia: Saunders; 2009:278-334.

Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691-7.

Calvo E, Morcillo D, Foruria AM, Redondo-Santamaría E, Osorio-Picorne F, Caeiro JR. Nondisplaced proximal humeral fractures: high incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception. J Shoulder Elbow Surg. 2011;20(5):795-801.

Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop. 2006;442:87-92.

Okike K, Lee OC, Makanji H, Harris MB, Vrahas MS. Factors associated with the decision for operative versus non-operative treatment of displaced proximal humerus fractures in the elderly. Injury. 2013;44(4):448-55.

Paryavi E, Pensy RA, Higgins TF, Chia B, Eglseder WA. Salvage of upper extremities with humeral fracture and associated brachial artery injury. Injury. 2014;45(12):1870-5.

Handoll HHG, Ollivere BJ, Rollins KE. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2012;12:CD000434.

Thorsness R, English C, Gross J, Tyler W, Voloshin I, Gorczyca J. Proximal humerus fractures with associated axillary artery injury. J Orthop Trauma. 2014;28(11):659-63.

Bono CM, Grossman MG, Hochwald N, Tornetta P. Radial and axillary nerves. Anatomic considerations for humeral fixation. Clin Orthop. 2000;(373):259-64.

Ninck J, Heck S, Gick S, Koebke J, Pennig D, Dargel J. Treatment of proximal humerus fractures: relative position of different locking plates to the axillary nerve. Unfallchirurg. 2013;116(11):1000-5.

Clement ND, Duckworth AD, McQueen MM, Court-Brown CM. The outcome of proximal humeral fractures in the elderly: predictors of mortality and function. Bone Joint J. 2014;96-B(7):970-7.

Carofino BC, Leopold SS. Classifications in brief: the Neer classification for proximal humerus fractures. Clin Orthop. 2013;471(1):39-43.

Gallo RA, Sciulli R, Daffner RH, Altman DT, Altman GT. Defining the relationship between rotator cuff injury and proximal humerus fractures. Clin Orthop. 2007;458:70-7.

Spross C, Zeledon R, Zdravkovic V, Jost B. How bone quality may influence intraoperative and early postoperative problems after angular stable open reduction-internal fixation of proximal humeral fractures. J Shoulder Elbow Surg. 2017;26(9):1566-72.

Jung S-W, Shim S-B, Kim H-M, Lee J-H, Lim H-S. Factors that influence reduction loss in proximal humerus fracture surgery. J Orthop Trauma. 2015;29(6):276-82.

Grawe B, Le T, Lee T, Wyrick J. Open reduction and internal fixation (ORIF) of complex 3- and 4-part fractures of the proximal humerus: does age really matter?. Geriatr Orthop Surg Rehabil. 2012;3(1):27-32.

Goch AM, Christiano A, Konda SR, Leucht P, Egol KA. Operative repair of proximal humerus fractures in septuagenarians and octogenarians: does chronologic age matter?. J Clin Orthop Trauma. 2017;8(1):50-3.

Koval KJ, Gallagher MA, Marsicano JG, Cuomo F, McShinawy A, Zuckerman JD. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997;79(2):203-7.

Tamimi I, Montesa G, Collado F. Displaced proximal humeral fractures: when is surgery necessary?. Injury. 2015;46(10):1921-9.

Kancherla VK, Singh A, Anakwenze OA. Management of acute proximal humeral fractures. J Am Acad Orthop Surg. 2017;25(1):42-52.

Olerud P, Ahrengart L, Söderqvist A, Saving J, Tidermark J. Quality of life and functional outcome after a 2-part proximal humeral fracture: a prospective cohort study on 50 patients treated with a locking plate. J Shoulder Elbow Surg. 2010;19(6):814-22.

Zhu Y, Lu Y, Shen J, Zhang J, Jiang C. Locking intramedullary nails and locking plates in the treatment of two-part proximal humeral surgical neck fractures: a prospective randomized trial with a minimum of three years of follow-up. J Bone Joint Surg Am. 2011;93(2):159-68.

Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011;20(5):747-55.

Hessmann MH, Hansen WSM, Krummenauer F, Pol TF, Rommens PM. Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation. J Trauma. 2005;58(6):1194-201.

Kitson J, Booth G, Day R. A biomechanical comparison of locking plate and locking nail implants used for fractures of the proximal humerus. J Shoulder Elbow Surg. 2007;16(3):362-6.

Newman JM, Kahn M, Gruson KI. Reducing postoperative fracture displacement after locked plating of proximal humerus fractures: current concepts. Am J Orthop. 2015;44(7):312-20.

Gavaskar AS, Karthik BB, Tummala NC, Srinivasan P, Gopalan H. Second generation locked plating for complex proximal humerus fractures in very elderly patients. Injury. 2016;47(11):2534-8.

Çelik C, Gümüştaş SA, Çeçen GS, Bulut G, Bekler Hİ. Mid-term follow-up evaluation of plate osteosynthesis and hemiarthroplasty results in multipart fractures of the proximal humerus. Ulus Travma Acil Cerrahi Derg. 2016;22(4):379-85.

Bengnér U, Johnell O, Redlund-Johnell I. Changes in the incidence of fracture of the upper end of the humerus during a 30-year period. A study of 2125 fractures. Clin Orthop Relat Res. 1988;231:179-82.

Gaebler C, McQueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand. 2003;74(5):580-5.

Agarwal S, Rana A, Sharma RK. Functional outcome after primary hemiarthroplasty in three or four part proximal humerus fracture: A short term followup. Indian J Orthop. 2016;50(6):590-4.

Fazal MA, Haddad FS. Philos plate fixation for displaced proximal humeral fractures. J Orthop Surg. 2009;17(1):15-8.

Aggarwal S, Bali K, Dhillon MS, Kumar V, Mootha AK. Displaced proximal humeral fractures: an Indian experience with locking plates. J Orthop Surg Res. 2010;5:60.

Sachde B, Sayani K, Maru N. The proximal humerus locking plate as a fixation modality in proximal humeral fractures: preliminary results. Int J Orthop Surg. 2012;19(3).

Gerber C, Schneeberger AG, Vinh TS. The arterial vascularization of the humeral head. An anatomical study. J Bone Joint Surg Am. 1990;72(10):1486-94.

Gaheer RS, Hawkins A. Fixation of 3- and 4-part proximal humerus fractures using the PHILOS plate: mid-term results. Orthopedics. 2010;33(9):671.

Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009;23(3):163-72.

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Published

2020-12-23

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Original Research Articles