Background: Management of proximal humerus fractures still remains controversial. The goal of proximal humerus fracture fixation is to achieve stable anatomical reduction and to allow early mobilization. There are many methods of fixation of proximal humerus fractures. This study focuses on fuctional outcome of proximal humeral fractures fixed with Proximal Humeral Internal Locking Osteosynthesis System (PHILOS) plating. Methods: Fifty-five patients who underwent surgery with PHILOS plate for displaced proximal humerus fractures were analysed. The classification method used was Neer's classification. All patients had a radiographic and clinical follow-up performed at one, three and six weeks, one and six months and at one and two years. The clinical outcomes were measured with the use of the Constant-Murley system. Results: Out of 55 patients, 10 patients (18%) had excellent functional outcome, 34 patients (62%) had good outcome, 8 patients (15%) had moderate outcome and 3 patients (5%) had poor outcome according to Constant-Murley scoring system. Complications were noted in 10 of 55 patients. The mean Constant-Murley score was 75.27 ± 10.56. The mean time to bone union was about 12 weeks in 90% of patients. Ten patients developed complications (18.18%) which included 1 avascular necrosis (1.82%), 3 impingements (5.45%), 2 implant failures (3.64%), 2 nonunions (3.64%) and 2 stiffness (3.64%). The mean Constant Murley score for Neer's two-part fracture was 84.83 ± 8.77, for three part it was 79.91 ± 6.24 and for four part fracture the score was 68.52 ± 10.27. Mean Constant Murley for patients aged < 60 years was 80.73 ± 7.15 and the score for more than 60 years age was 68.72 ± 10.35. The correlation between mean Constant Murley score and Neer's 2, 3 and 4 part fractures (p < 0.001) and age (p < 0.0001) was found to be considered statistically significant. Conclusion: Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. The PHILOS plate is an ideal construct and a stable implant to use for fractures of the proximal humerus in Neer's 2-part, 3-part, and 4part and osteoporotic fractures. Proper surgical technique and skills can be incorporated to avoid the complications.
Background: Clavicle fractures are common, with an overall incidence of 36.5 -64 per 100,000 people every year. Traditionally, midshaft clavicle fractures have been treated nonoperatively. Recently, there has been increasing interest in the operative treatment and plate fixation or intramedullary nailing is often the treatment modality of choice. Numerous clinical studies have been published to compare surgical and conservative treatments. The best treatment for displaced midshaft clavicle fractures remains a topic of debate. So We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after operative treatment of displaced midshaft clavicular fractures. Objectives: To compare functional outcome and complication rates following nonoperative treatment and those after operative treatment of displaced midshaft clavicular fractures. Materials and Methods: 60 patients with a displaced midshaft fracture of the clavicle who were presented to RL Jalappa Hospital from June 2015 to October 2016 and either treated by conservative or operative methods of treatment and who were in regular follow up are selected. Functional assessment was done at 6 weeks, 3 months and 6 months with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scores Complications, if any will be recorded. Results: DASH Scores and Constant scores were significantly better in the operative group compared to the conservative group at all time points. Conclusion: Operative treatment resulted in early return to function compared to conservative treatment but at the cost if complications like infection and other hardware related problems.
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