Lokesh Holagundi1, Hemanth H. P2, Dayanand M3, Deepak Shivanna4, Vishwas Hosur Ravishankar5

For more displaced fractures and osteopenic bone, techniques of internal fixation, which emphasise less disruptive soft tissue dissection, and minimal fixation with wire and non-absorbable sutures have been successful with a low complication rate. Even AO type buttress plates are being used, but they require more soft tissue dissection and may lead to infection. Management of these fractures is associated with some morbidity and undesirable sequelae. They include complications like avascular necrosis, malunion, non-union, infection, neurovascular injury, loss of motion of shoulder from adhesive capsulitis, chronic oedema, elbow stiffness and atrophy of the soft tissues of the immobilised limb causing significant disability during healing and afterwards. The purpose of this study is to evaluate the functional outcome of the surgical management of fresh displaced three- and four-part proximal humerus fractures with locking plate system.
The present study was carried out from August 2012 to December 2014 at Orthopaedic Department in Bangalore Medical College and Hospital. During this period, 25 patients of proximal humerus fractures were treated with locking plates. All patients were followed up for every 4 weeks. Local examination of the affected shoulder for tenderness, instability, deformity and shoulder movements were assessed. X-rays were taken at each visit to know about progressive fracture union and implant position. Rehabilitation of the affected extremity was done according to the stage of fracture union and time duration from surgery. Patients were followed up till radiological union.
The present study consists of 25 patients of fresh three- and four-part fractures of proximal humerus which were treated surgically with locking plates from August 2012 to December 2014. All the patients were available for follow-up and they were followed every month for first 3 months then once in 3 months. In this study, NEER classification was followed. There were 15(60%) three-part fractures, 9(36%) four-part fractures, and 1(4%) three-part fracture dislocation. A total of 24(96%) fractures united clinically and radiologically at the end of 12 weeks. In 1 patient (4%), delayed union occurred. It was in patient with three-part fracture dislocation. That was united at the end of 20 weeks. The functional outcome is assessed by Constant and Murley score at the end of 20 weeks. Showed excellent results in 8(32%) patients and good in 10(40%) patients. Fair results in 4(16%) patients due to restriction of shoulder movements and poor in 3(12%) due to one or more complications. The mean Constant score in this study was 77.
Our result demonstrated that the locking proximal humerus plate provides secure and stable fracture fixation for early mobilisation especially in osteoporotic bone. Early results with locking plate system were promising, the technique is not a panacea and numerous complications also occurred.