FOUR PART PROXIMAL HUMERAL FRACTURES: TO FIX OR NOT TO FIX?

A Arya; S Garg; J Sinha

doi:10.1302/0301-620X.91BSUPP_II.0910208d

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FOUR PART PROXIMAL HUMERAL FRACTURES: TO FIX OR NOT TO FIX?

A Arya
S Garg
J Sinha

FOUR PART PROXIMAL HUMERAL FRACTURES: TO FIX OR NOT TO FIX?

Arya A, Garg S, Sinha J. FOUR PART PROXIMAL HUMERAL FRACTURES: TO FIX OR NOT TO FIX?. Orthop Procs. 2009;91-B(SUPP_II):208-208. doi:10.1302/0301-620X.91BSUPP_II.0910208d

Arya, A, et al. “FOUR PART PROXIMAL HUMERAL FRACTURES: TO FIX OR NOT TO FIX?.” Orthopaedic Proceedings, vol. 91-B, no. SUPP_II, 2009, pp. 208-208., https://doi.org/10.1302/0301-620X.91BSUPP_II.0910208d

Arya, A., Garg, S., & Sinha, J. (2009). FOUR PART PROXIMAL HUMERAL FRACTURES: TO FIX OR NOT TO FIX?. Orthopaedic Proceedings, 91-B(SUPP_II), 208-208. https://doi.org/10.1302/0301-620X.91BSUPP_II.0910208d

Arya, A., Garg, S. and Sinha, J. (2009) “FOUR PART PROXIMAL HUMERAL FRACTURES: TO FIX OR NOT TO FIX?.” Orthopaedic Proceedings, 91-B(SUPP_II), pp. 208-208. Available at: https://doi.org/10.1302/0301-620X.91BSUPP_II.0910208d

Arya, A, S Garg, and J Sinha. “FOUR PART PROXIMAL HUMERAL FRACTURES: TO FIX OR NOT TO FIX?.” Orthopaedic Proceedings 91-B, no. SUPP_II (2009): 208-208. https://doi.org/10.1302/0301-620X.91BSUPP_II.0910208d

Arya A, Garg S, Sinha J. FOUR PART PROXIMAL HUMERAL FRACTURES: TO FIX OR NOT TO FIX?. Orthop Procs. 2009 May 1;91-B(SUPP_II):208-208. https://doi.org/10.1302/0301-620X.91BSUPP_II.0910208d

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Abstract

Four part (Neer’s) proximal humeral fractures if treated by fixation are prone to develop avascular necrosis of humeral head; requiring further treatment and possible reoperation. This has led to the popularity of hemiarthroplasty as the primary treatment in these fractures. Since the availability of contoured locking compression plate (PHILOS) in our unit, we have treated most of the 4 part proximal humeral fractures by internal fixation. The aim of this study was to assess the usefulness of the PHILOS plate in the treatment of these fractures.

We prospectively reviewed 21 patients (mean age 57 yrs) operated between March 2002 and January 2006 at a level 1 trauma centre, using 3/5 hole PHILOS plate for fixation. An independent observer reviewed them postoperatively at 6 monthly intervals for clinical and radiological assessment. Outcome measures included DASH and Constant score. A SPECT/bone scan was done in appropriate cases.

18 patients were available for follow up, which ranged from 12–66 (average 24.4) months. Recovery of movements and relief in pain was satisfactory in most of the patients with mean Constant score of 63 points (range 37 to 95) and DASH score of 20 points (range 15–78) at last follow up.. We encountered a few complications including non-union (1); implant breakage (1) and impingement (4). Only one patient in our series required hemiarthroplasty; out of two who developed symptomatic avascular necrosis. Patient satisfaction was high in spite of moderate Constant score. Removal of PHILOS plate was difficult in some cases due to problem of cold welding and distortion of screw heads. The broken plate was subjected to biomechanical and metallurgical analysis, which revealed that the plate is inherently weak at the site of failure.

Our series is comparatively small to draw any firm conclusions but we feel that with the availability of better implants, there is a case to consider the fixation rather than arthroplasty as the primary treatment of 4 part proximal humeral fractures.

Level of evidence: Therapeutic study – Level IV (prospective case series)

Correspondence should be addressed to Mr Bimal Singh, c/o BOSA at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE