Abstract

Introduction: Fractures of proximal humerus associated with dislocations pose a challenge in clinical decision making and management. Open Reduction and Internal Fixation (ORIF) can be done by plating, Kirshner wires (K-wires) or cancellous screws. The Proximal humeral internal locking system (PHILOS) plate provides greater angular stability and better anchorage of screws in osteoporotic bone. Arthroscopic repair of the soft tissue defects and percutaneous fracture fixation using cannulated screws is an option. Surgery is known to result early joint mobilization and a good functional outcome.

Materials and Methods: This study was conducted from November 2015 and May 2019. Nine adult patients and one paediatric patient who sustained proximal humeral fracture dislocations after a convulsive episode were included. For the surgical treatment the delto-pectoral approach was used with the fracture being reduced and fixed with a PHILOS plate, cancellous screws or K-wires. The patients were evaluated for range of motion of the shoulder, features of clinical union and radiological union. Overall outcome was assessed using the Everisto Scoring System (ESS).

Results: Based on the ESS excellent results were recorded in 50%, good result in 33% and two patients had a poor outcome (20%). The range of motion at first, second and third follow ups showed gradual increase in forward flexion, abduction, external rotation and internal rotation.

Conclusion: Surgery provides a high degree of angular and axial stability with excellent functional outcomes in young patients. The use of ESS describes the outcome of shoulder fracture dislocations better in terms of disability and the need for further interventions.

Keywords: Proximal humerus fracture-dislocation; ORIF, Outcomes; Everisto’s scoring system (ESS).