Functional outcome and incidence of avascular necrosis after two years in four part proximal humeral fractures treated by proximal humerus internal locking system

Background: Fractures of proximal humerus are not uncommon, especially in older age groups. In osteoporotic bone requiring open reduction and internal fixation, locking plates offer the advantage of increased pull out resistance of the locking head screws compared with that of conventional screws. The aim of our study was to analyse the functional outcome and incidence of avascular necrosis in four part proximal humeral fractures managed with proximal humerus locking plate. Methods: It was a retrospective study of patients with NEER’s four part proximal humerus fractures treated by proximal humerus locking plate. Patients operated at Dayanand Medical College and Hospital, Ludhiana, Punjab, India from 1st January 2007 to 30 th June 2011 was included in the study with a minimum follow up of two years. Scoring system given by Constant et al was used for evaluation of functional outcome and results were graded as Excellent (score 80-100%), good (score 60-79%), fair (constant score 40-59%) or poor (constant score 0-39%). Results: In present study, a good to excellent result was achieved in 64.2 % patients. A mean constant score of 70.6 points was observed. Only 5.6% of patients had osteonecrosis of humeral head at 2-year follow up. Conclusions: The importance of early mobilization of the shoulder joint cannot be underestimated in the final outcome of these fractures. We observed better functional outcome in the patients who started early physiotherapy and continued it at home.