Int J Curr Pharm Res, Vol 16, Issue 2, 73-75Original Article

STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF OPEN REDUCTION AND INTERNAL FIXATION OF PROXIMAL HUMERUS FRACTURES WITH PROXIMAL HUMERUS LOCKING PLATE

DHAWAL GAMI*, PRAVIN BANDE, SAGAR WAJEKAR

Bhabha Atomic Research Centre Hospital, Anushakti Nagar, Mumbai, India
*Corresponding author: Dhawal Gami; *Email: dhaval.gami.92@gmail.com

Received: 20 Dec 2023, Revised and Accepted: 24 Jan 2024

ABSTRACT

Objective: Proximal humeral fractures, representing approximately 5% of all fractures, intricately challenge orthopaedic management, particularly in the geriatric demographic. Displaced variants, frequently encountered in the elderly, prompt surgical intervention to mitigate notable morbidity. The introduction of angular stable proximal humerus locking plates heralds a pivotal shift, purveying biomechanical robustness in osteoporotic contexts. This study meticulously assesses the efficacy of open reduction and internal fixation utilizing these plates, scrutinizing nuanced functional and radiological outcomes while elucidating intricate correlations with patients' Body Mass Index (BMI) and Cortical Index.

Methods: A prospective case study involving 31 adult patients with proximal humerus fractures unfolded over 1.5 y within the bastions of the Department of Orthopaedics at BARC Hospital. Inclusion criteria encompassed specific fracture morphologies, while exclusion criteria diligently precluded medically infirm subjects and isolated tuberosity fractures. Radiographic scrutiny encompassed parameters such as cortical index, fracture classification, neck-shaft angle, GT to AS distance, and medial hinge reduction. Functional assessments, including QuickDASH and Constant-Murley scoring, were conducted postoperatively at 3 and 6 mo. Correlation analyses interfacing with BMI and cortical index engendered a profound understanding.

Results: Demographic analysis revealed a preponderance of participants (32.3%) within the 61-70 age bracket, with 54.8% manifesting Neer 2-part fractures. The cohort exhibited an average BMI of 26.27 (SD = 4.29), coupled with a Cortical Index averaging 0.216 (SD = 0.012). Significantly improved QuickDASH scores, dwindling from 25.54±6.74 at 3 mo to 13.16±8.57 at 6 mo (p<0.0001), underscored noteworthy clinical advancement. Complications, while relatively infrequent, manifested in 6.5% as screw penetration and 9.7% as superficial infection.

Conclusion: This study offers profound insights into the efficacy of angular stable proximal humerus locking plates for proximal humerus fractures. The discerned stability in anatomical metrics, coupled with substantial functional amelioration and a judiciously low complication milieu, emphatically underscores the procedural effectiveness. Correlation analyses unmask intricate associations with BMI and cortical index. Despite auspicious outcomes, ongoing research imperatively seeks refinement of understanding and the delineation of prophylactic measures for complications.

Keywords: Proximal humeral fractures, Angular stable locking plates, Open reduction, Internal fixation, Body mass index (BMI), Cortical index, QuickDASH, Constant-murley, Complications

© 2024 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijcpr.2024v16i2.4034 Journal homepage: https://innovareacademics.in/journals/index.php/ijcpr

INTRODUCTION

Proximal humeral fractures, localized at or proximal to the surgical neck of the humerus, pose intricate challenges, constituting approximately 5% of all fractures. Predominantly observed as the third most prevalent fracture type in individuals aged over 65, these fractures result from either high-energy trauma in the younger demographic or trivial trauma exacerbated by osteoporosis in the elderly [1].

While conservative management suffices for stable fractures, the displaced and unstable variants, prevalent among the elderly, present notable morbidity. The treatment objective aligns with AO/ASIF principles, emphasizing acceptable reduction, stable fixation, and early mobilization. Diverse modalities, from percutaneous pins to hemiarthroplasty, have been explored, each with its merits and complications [2].

A paradigm shift occurred with the advent of angular stable proximal humerus locking plates, particularly pre-contoured ones. Operating on the principles of angular stability, minimal vascularity disruption, and three-dimensional screw distribution, these plates offer biomechanical strength in osteoporotic bone and decreased failure rates. Our study aims to assess the efficacy of open reduction and internal fixation using these plates for displaced proximal humerus fractures.3 By scrutinizing functional and radiological outcomes, we seek to unravel the potential of this innovative approach and establish correlations with patients' BMI and cortical index. In navigating the intricacies of proximal humerus fractures, angular stable locking plates emerge as promising instruments in the orthopaedic arsenal [4].

MATERIALS AND METHODS

Study area

The investigation was conducted at the Department of Orthopaedics, BARC Hospital, encompassing the Outpatient Department (OPD), Ward, and Emergency Department.

Study population

All adult patients meeting inclusion and exclusion criteria, attending orthopaedics OPD, Emergency Department, or admitted to the orthopaedics and traumatology ward with proximal humerus fractures.

Inclusion criteria

Exclusion criteria

Sample size

A prospective case study involving 31 adult patients with a follow-up period of 3 to 6 mo, calculated based on the DASH score with a 95% confidence interval.

Study design

An analytical cross-sectional, single-center study conducted over 1.5 y

Study technique

  1. Radiographic imaging for parameters like cortical index, fracture classification, neck-shaft angle, GT (greater tuberosity) to AS (articular surface) distance, and medial hinge reduction.

  2. QuickDASH and constant-murley scoring for functional assessment.

Study duration: 1.5 y

Pre-operative assessment

Patients underwent initial evaluation, resuscitation, and a comprehensive clinical examination. Immobilization using a shoulder immobilizer preceded surgery based on NEER criteria. Necessary investigations and CT scans were conducted for complex fractures.

Choice of anesthesia

Patients were operated under supraclavicular and interscalene block/general anesthesia.

Positioning the patient

Supine positioning with a sandbag between the spine and scapula of the affected side facilitated joint access.

Surgical approach

Deltopectoral approach was employed for all patients.

Operative technique

Post-operative management

Follow-up radiographs

Routine radiographs at 6 w, monthly for 3 mo, and 6 mo postoperatively to assess alignment, reduction, and complications.

Functional outcome assessment

QuickDASH and Constant-Murley scores at 3 and 6 mo post-op. Correlation of BMI and cortical index with functional and radiological outcomes for a comprehensive understanding.

RESULTS

The table shows the distribution of the age of participants in a study. There were a total of 31 participants. The majority of participants, 32.3%, fell within the age range of 61-70 y, followed by 29.0% in the age range of 51-60 y. A smaller percentage of participants were in the age ranges of 71-80 y (22.6%), less than or equal to 50 y (9.7%), and more than 80 y (6.5%). The mean age of all participants was 65.129 y, with a standard deviation of 10.128 y.

Table 1: Distribution of age of participants

Age Frequency Percent
Less or equal 50 Y 3 9.7
51-60 Y 9 29.0
61-70 Y 10 32.3
71-80 Y 7 22.6
More than 80 Y 2 6.5
Total 31 100.0
mean±SD 65.129±10.128

The table displays the distribution of Neer types among the participants in a study. Out of the total 31 participants, the majority, accounting for 54.8%, had a Neer type of 2-part. The next most prevalent Neer type was 3-part, which constituted 35.5% of the participants. The least common Neer type was 4-part, representing 9.7% of the participants.

Table 2: Distribution of neer type of participants

Neer type Frequency Percent
2 part 17 54.8
3 part 11 35.5
4 part 3 9.7
Total 31 100.0

Table 3: Distribution of BMI and cortical index of participants

Descriptive statistics
N Minimum Maximum Mean Std. deviation
BMI 31 18.80 34.70 26.2710 4.28697
Cortical index 31 0.193 .236 .21594 .012436

The participants in the study had an average BMI of 26.27 (SD = 4.29) and the Cortical Index with an average of 0.216 (SD = 0.012)

Table 4: Comparison of quick dash score AT 3 and 6 mo

Quickdash score Mean N Std. deviation T value P value
Quick DASH score in 3 mo 25.5484 31 6.74210 12.209 <0.0001*
Quick DASH score in 6 mo 13.1613 31 8.57942

The table compares the mean Quick DASH scores at 3 mo and 6 mo in a group. At 3 mo, the mean Quick DASH score was 25.54±6.74. At 6 mo, the mean Quick DASH score decreased significantly to 13.16±8.57. The t-value is 12.209, and the corresponding p-value is<0.0001, indicating a statistically significant difference in the Quick DASH scores.

Table 5: Distribution of complications of patients

Complications Frequency Percent
Nil 26 83.9
Screw penetration 2 6.5
Superficial infection 3 9.7
Total 31 100.0

The table indicates that among the 31 patients included in the study, the majority (83.9%) did not experience any complications. However, a small percentage of patients did encounter complications, with screw penetration occurring in 6.5% of cases and superficial infection in 9.7% of cases.

DISCUSSION

The investigation into a specific surgical procedure targeting proximal humerus fractures yielded comprehensive insights into participant characteristics, anatomical measurements, functional outcomes, and complications.5 The demographic analysis revealed a predominance of individuals aged 61-70 y, consistent with the higher incidence of the condition in older populations. Gender distribution favoured males, a trend observed in similar orthopaedic studies. The side of surgery, Neer types, BMI, and Cortical Index were well-distributed, aligning with established literature and emphasizing the study's representativeness [6].

Analysing anatomical measurements, stability in neck shaft angle, GT to AS distance, and medial hinge reduction was evident over a 6-mo period. While the neck shaft angle slightly decreased, these changes were statistically insignificant, corroborating findings from previous studies [7]. The GT to AS distance remained unchanged, in agreement with existing literature, indicating the surgical procedure's limited impact on this anatomical aspect. Medial hinge reduction showed minimal variation, consistent with limited available studies, reinforcing the stability of this parameter post-surgery [8].

Functional outcomes, assessed through Quick DASH and Constant-Murley scores, demonstrated significant improvement, reflecting enhanced shoulder function and overall well-being. These improvements align with prior research and underline the positive impact of the surgical intervention. Correlation analyses uncovered nuanced relationships between variables, highlighting associations between BMI, Cortical Index, anatomical measurements, and functional outcomes. Higher BMI correlated with lower Constant-Murley scores, emphasizing the potential influence of body mass on postoperative shoulder function.

Complications were relatively infrequent, with the majority of participants experiencing none. Screw penetration and superficial infection, while presenting in a small percentage of cases, mirrored rates reported in comparable studies. Further research is essential to identify risk factors and preventive measures for these complications [9, 10].

CONCLUSION

In conclusion, this study contributes valuable insights into a specific surgical intervention for proximal humerus fractures. The stability observed in anatomical measurements, coupled with significant improvements in functional outcomes, underscores the procedure's efficacy. Despite a relatively low complication rate, the occurrence of screw penetration and superficial infection warrants continued investigation.

FUNDING

Nil

AUTHORS CONTRIBUTIONS

All authors have contributed equally

CONFLICT OF INTERESTS

Declared none

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