Study of Proximal Humerus Fractures Treated by Anatomical Locking Plates

Abstract

Background and objectives: Treatment of the proximal humerus fracture is controversial and various operative modalities have been tried in literatures. Difficulties in Open reduction and internal fixation have been multi-factorial including osteoporotic bone, angular instability, implant impingement, loss of reduction and backing out of screws. Anatomical plates are pre-shaped and pre-contoured with fixed angle relationship between the screws and plate. The locking screw, provide angular as well as axial stability. Thus objectives of our study were to evaluate the results of proximal humerus anatomical plate in various groups like young and old patients, Neer’s type 2, 3 & 4 fractures with emphasis on fracture union, functional outcome and complications. Methods: The study analyzed 15 men and 10 women aged 26 to 75 (mean, 46.64) years with Neer’s 2, 3 & 4 part proximal humerus fractures treated by anatomical locking plate. Patients were followed for a minimum period of 6 months. Functional outcomes and shoulder range of movements were assessed based on the Constant and Murley scoring system. At the final follow-up results were compared between 2-part, 3-part & 4-part fractures, between younger (≤60) and older (˃60) and between different modes of injury. Results: In our study, 13 cases had 2 part fractures as per Neer's classification, while 11 cases had 3 part and 2 had four part fractures with the mean follow up of 11.8 (range 6-18) months. At final follow up the mean Constant score was 71.07 for 2 part fractures, 64.14 for 3 part fractures, 47.75 for 4 part fractures with the mean Constant score of 68.78. Out of 26 cases, 3 (11.54%) had excellent outcome, 12 (46.15%) had good outcome, 8 (30.77%) had fair outcome and 3 (10%) had poor outcome. Results were satisfactory in patients younger than 60 years, while unsatisfactory results were seen in more than 60 years of age. In our study, Right (56%) upper limb was more commonly involved than Left (40%) while 1 patient had bilateral involvement. Complications encountered in this study were shoulder stiffness in 5 (19.23%), xii malunion in 3 (11.54%), infection in 1 (3.85%), impingement of implant in 1 (3.85%), implant loosening (failure of implant) in 1 (3.85%) and screw perforation in 1 (3.85%) case. Conclusion: Anatomical locking plate leads to satisfactory functional outcomes in 2 & 3 part fractures but results are unsatisfactory in 4 part fractures and in elderly people. This study teaches us that in fractures of proximal humerus, restoration of joint congruity is vital for restoration of joint function. Restriction of abduction and external rotation suggests that greater tuberosity fragment must be anatomically reduced well. Strict adherence to shoulder mobilisation protocols and part of patient compliance can improve the further results.