Comparison of Functional Outcome of Fracture Proximal Humerus Treated with Open Reduction and Plate Osteosynthesis V/S Closed Reduction and Wire Fixation

Abstract

Introduction: Fractures of the proximal humerus constitute about 4% of all fractures and 26% of humerus
fractures. Treatment of fracture proximal humerus has always been controversial. Many studies indicate that
the majority of favourable results of these fractures are achieved by conservative method. Whereas some
other studies suggest that surgical management is better.
Aim: The aim of this study was to compare functional outcome between Open Reduction and Plate
Osteosynthesis and Closed Reduction with wire Fixation of Fracture of proximal humerus.
Method and Materials: 30 patients with fracture of proximal humerus were first categorized according to
Neer’s classification and were divided alternatively into Proximal Humerus Interlocking System (PHILOS)
group which is named Group A and wiring group which was called Group B according to randomized
control study design. These patients were then followed up for 12 months. The results were compared using
Constant-Murley score.
Results: In our study, the favourable outcome was seen in 12 patients out of 15 in group A (80%) whereas
in group B the favourable outcome was seen in 9 out of 15 patients (60%) which is statistically insignificant.
At the final follow up after 1 year, the final mean Constant and Murley’s score was 78.4 for group A while it
was 70.13 for group B which is statistically significant showing better results with Philos.
Complications: Complications seen in group A were 3 shoulder stiffness, 1 varusmalunion and 1 subacromial
impingement, 1 superficial infection while in group B, 5 shoulder stiffness, 2 varusmalunion, 3 superficial
infection, 2 wire migration. There were no incidences of non-union & osteonecrosis of the head of proximal
humerus.
Conclusion: Based on the analysis of the results, we recommend that ORIF with PHILOS is desirable
for optimal outcome in patients of fracture proximal humerus. However for low demand patient, closed
reduction and wire fixation is also an option.