Abstract
Background: Proximal humeral fractures account for 4–5% of all fractures; most of them involving elderly and osteoporotic people. 1 51% of such fractures are displaced. Two Fractures with minimal displacement, regardless of the number of fracture lines, can be treated with closed reduction and early mobilization, but anatomical reduction in displaced fractures is difficult to obtain and the incidence of pseudarthrosis is high 3–5. We evaluated the functional results of closed Neer’s 2- and 3-part proximal humerus fractures treated by Joshi’s external stabilizing system.
Materials and Methods: Sixteen patients with proximal humeral fractures were managed from 2008 to 2010 by Joshi’s stabilizing external fixation. They were 10 males and 6 females, with a mean age of 57.5 years. Based on Neer’s classification, there were eleven 3-part fractures and five 2-part fractures. The mechanism of injuries included seven road traffic accidents and nine fall. Shoulder mobilization exercises were started within 1 week after stabilization with JESS. External fixation was removed after the evidence of union (6–8 weeks). Pain was evaluated by visual analogue scale (VAS) and shoulder range of motion was evaluated by Constant Scoring System. Followup was done at 4 weeks, 8 weeks, 12 weeks, and then at every 4 weeks.
Results: Mean followup was of 20.5 months (range 9–30 months). Postoperative mean VAS score and Constant Score of patients was 2.1 (±0.73) and 78.1 (±9.61) at an average followup of 6 months. Mean duration for union was 6.5 (±1.18) weeks. One case of K-wire loosening and one case of pin tract infection were the complications noted.
Conclusion: External fixation by JESS is an alternative option to treat Neer’s 2 and 3 part proximal humerus fractures with good results.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Handoll HH, Gibson JN, Madhok R. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 2003;4:CD000434.
Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001;72:365–71.
Clifford PC. Fractures of the neck of the humerus: A review of the late results. Injury 1980;12:91–5.
Kristiansen B, Christensen SW. Proximal humeral fractures. Late results in relation to classification and treatment. Acta Orthop Scand 1987;58:124–7.
Stableforth PG. Four-part fractures of the neck of the humerus. J Bone Joint Surg Br 1984;66:104–8.
Drosdowech DS, Faber KJ, Athwal GS. Open reduction and internal fixation of proximal humerus fractures. Orthop Clin North Am 2008;39:429–39.
Young AA, Hughes JS. Locked intramedullary nailing for treatment of displaced proximal humerus fractures. Orthop Clin North Am 2008;39:417–28.
Kristiansen B. External fixation of proximal humerus fracture. Clinical and cadaver study of pinning technique. Acta Orthop Scand 1987;58:645–8.
Kristiansen B, Kofoed H. Transcutaneous reduction and external fixation of displaced fractures of the proximal humerus. A controlled clinical trial. J Bone Joint Surg Br 1988;70:821–4.
Hodgson SA, Mawson SJ, Stanley D. Rehabilitation after two-part fracture of the neck of the humerus. J Bone Joint Surg 2003;85:419–22.
Jakob RP, Miniaci A, Anson PS, Jaberg H, Osterwalder A, Ganz R. Four-part valgus impacted fracture of the proximal humerus. J Bone Joint Surg 1991;73:295–8.
Zyto K, Kronberg M, Brostrom LA. Shoulder function after displaced fractures of the proximal humerus. J Shoulder Elbow Surg 1995;4:331–6.
Koval KJ, Blair B, Takei R, Kummer FJ, Zuckerman JD. Surgical neck fractures of the proximal humerus: A laboratory evaluation of ten fixation techniques. J Trauma 1996;40:778–3.
Siegel J, Dines D. Proximal humerus malunions. Orthop Clin North Am 2000;31:35–49.
Wijgman AJ, Roolker W, Pall TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fracture of the proximal part of the humerus. J Bone Joint Surg 2002;84:1919–25.
Neer CS. Displaced humeral fractures. J Bone Joint Surg 1970;52:1077–89.
Hirschmann MT, Fallegger B, Amsler F, Regazzoni P, Gross T. Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma 2011;25:286–93.
Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3 part proximal humeral fractures in elderly patients: A randomized controlled trial. J Shoulder Elbow Surg 2011;20:747–55.
Altay T, Karapinar L, Kaya A, Oztürk H. Treatment of two-part proximal humeral fractures with external fixators. Ulus Travma Acil Cerrahi Derg 2005;11:153–6.
Monga P, Verma R, Sharma VK. Closed reduction and external fixation for displaced proximal humeral fractures. J Orthop Surg (Hong Kong) 2009;17:142–5.
Kristiansen B. External fixation of proximal humerus fracture. Clinical and cadaver study of pinning technique. Acta Orthop Scand 1987;58:645–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gupta, A.K., Gupta, M., Sengar, G. et al. Functional outcome of closed fractures of proximal humerus managed by Joshi’s external stabilizing system. IJOO 46, 216–220 (2012). https://doi.org/10.4103/0019-5413.93679
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.93679