The Study of Clinical, Functional and Radiological Outcome of Proximal Humerus Fractures Treated With Locking Plates Using UCLA Shoulder Score
Journal Title: International Journal of Research and Review - Year 2018, Vol 5, Issue 9
Abstract
Background: Proximal humeral fractures now account for 4 to 5% of all fractures. They are the second most common fractures of upper-extremity. They are also the third most common fracture after fractures around the hip joint and fractures of distal radial, in patients who are older than sixty-five years of age. This frequency increases in relation to Osteoporosis. In younger age group, fractures of proximal humerus occur following high velocity trauma. Majority of proximal humeral fractures which are non-displaced or minimally displaced can be treated with sling immobilization and physical therapy, however approximately 20% of displaced proximal humeral fractures require operative treatment for beneficial outcome. Treatment of unstable, displaced and comminuted fractures of proximal humerus remains a challenge. Patients and method: After obtaining clearance from hospital ethical board, patients who underwent Locking plate for Proximal Humerus Fracture at a tertiary care center, Mumbai, who have given written and informed consent. Patients fitting into inclusion criteria would form the study group. Sample size was calculated using Post-hoc analysis sample size calculator. Data collected by interviews, observation of clinical and radiological findings and assessment of function done using UCLA shoulder score. Categorical data was analyzed by using Chi-square test and comparison of results done using Paired t test. Results: The study comprised of 40 patients, with a mean age of 60.97± 4.78 years who suffered proximal Humerus fracture and managed by locking compression plate at our centre. There was female predominance in our study. Right side, dominant side was affected more often. Most of the fractures were due to high velocity injury. 2 part fracture were more commonly encountered in our study accounting for 60% of the patients. Majority of patients took 12 weeks for union with mean union time of 11.45 weeks with standard deviation of ± 2.12. Patients were asked to follow up routinely, with post operative follow up ranging from minimum of 20 weeks to 9 months. At final follow up following results obtained according to UCLA shoulder Score, with 67.5% patients had Excellent and Good results. Conclusions: In proximal humerus locking compression plate system, locking of the threaded heads of the screws in the plate itself provides for a construct with angular and axial stability, eliminating the possibility of screw toggling (windscreen wiper effect), or sliding of the screws in the plate holes. Coupled with a divergent or convergent screw orientation to head of humerus provide improved resistance to pull out and failure of fixation. Also, whereas conventional plating systems depend on compression between the plate under surface and bone for stability, this is not the case for the locking plates. This also allows for a more biological fixation as the underlying periosteum and blood supply to the fractured regions are much less compressed. The rehabilitation programme plays important role in functional outcome of surgical management of proximal humerus fracture by early mobilization and return to pre operative functional status.
Authors and Affiliations
Dr. Pawal Gajendra Prabhakar
Keywords
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