Title: The Influence of Oblique Inferomedial Screws on Secondary Loss of Reduction and Functional Outcome in Proximal Humerus Fractures Treated with Locked Compression Plating - A Comparative Study
Authors: Dr Murukan Babu, Dr Tom Jose, Dr Sujith Thampy
DOI: https://dx.doi.org/10.18535/jmscr/v5i9.172
Abstract
Aim: To investigate the influence of calcar screws on secondary loss of reduction and functional outcome in proximal humerus fractures treated with Locked compression plate.
Materials and Methods: All patients who underwent proximal humerus plating for 3 part and 4 part displaced fractures between January 2012 and October 2014 in HGM Hospital Muttuchira, were included. All patients were operated by deltopectoral approach and underwent same post-operative care. Total 47 patients, with an average age of 58, 27 patients without calcar screws were in 1st group, 20 patients with calcar screws were in 2nd group. Radiological and functional outcome were assessed post operatively and at follow up in 6 weeks, 3 months, 6 months and 1 year. The functional outcome was assessed using UCLA shoulder score.
Results: The results showed there is significant loss of reduction in follow up X rays compared to immediate post op X rays in 1st group. In 2nd group, varus collapse and loss of reduction were minimal. In the 2nd group, the average loss of humeral head height was 1.2 mm. In the 1st group (without an appropriately placed inferomedial oblique screw), loss of humeral height averaged 5.8 mm.
Discussion: The presence of medial support had a significant effect on the magnitude of subsequent reduction loss. All fractures in both groups healed without delay. Subsequently, UCLA score and functional outcome were also significantly better for patients in 2 nd group. The placement of calcar screws in proximal humerus fracture fixation is associated with less secondary loss of reduction and varus collapse and yields better outcome
Keywords: Calcar screws, Inferiomedial screw, Proximal humerus fractures,Varus collapse,
