Functional Outcome of Diaphyseal Fractures of Shaft of Humerus Treated Surgically with Locking Compression Plates in Osteoporotic Bones: A Prospective study

Abstract

INTRODUCTION: Fractures of humeral diaphysis constitute 3% of all the bony injuries. The uniqueness in anatomy, the fracture configuration and the significance of the region influences the treatment option. The sleeve of muscles surrounding the bone and the rich vascularity provided by them helps in fracture healing. The mobility of the shoulder and the elbow joint accommodates for a minimal degree of angulation and shortening. Moreover the limb does not take part in weight bearing or ambulation; Hence some amount of shortening is functionally acceptable. But a rotational deformity is not acceptable. There are several practical advantages to the use of locking compression plates over standard compression plates. Loss of screw purchase is an important factor related to the failure of fixation in osteo porotic bone. Fracture plating technology recently has evolved to include locked plating. The main goal is to obtain the most rigid fixation possible. Locking compression plates fixation is being evaluated for its effectiveness in the treatment of humeral diaphyseal fractures in osteoporotic bones. AIM: Prospective study on functional outcome of diaphyseal fractures of shaft of humerus treated surgically with locking compression plate in mostly osteoporotic bones at Government Royapettah Hospital, Chennai between May 2006 and September 2007. MATERIALS AND METHODS: This prospective study is an analysis of functional outcome of 20 cases of surgically managed diaphyseal fractures of shaft of humerus in mostly osteoporotic bones and in fracture non-unions undertaken at Department of orthopedics and traumatology, Government Royapettah hospital, Chennai. From May 2006 to September 2007. Among the 20 patients 12 were females and 8 patients were males. The age of the patients ranged from 53 years to 83 years. The mean age of the patients was 67.15 years. The mode of injury was fall at ground level in 12 (60%) of patients, road traffic accidents in 6 (30%) patients, fall from height in2 (10%) patients. Sixteen patients presented to us within a week after injury and 8 patients had previous treatment either in the form of native splinting, massage or POP cast. A meticulous clinical examination was made in all patients with care to look for any associated injuries. 8 patients had associated injuries ipsilateral skeletal injuries which were concomitantly treated. RESULTS: The patients were followed up at regular intervals i.e., every month during the first 3 months and every 3 months thereafter. The minimum follow up period was 6months and the maximum follow up period was 15 months. The mean follow up period in this study was 9 months. The results were evaluated during follow up by taking into consideration the following factors: 1. Pain, 2. Range of motion, 3. Strength, 4. Stability, 5. Function, 6. Reontgenographic documentation of fracture healing, 7. Anatomic restoration. Constant score: Constant and Murley’s score was used to assess the functional outcome of these patients. The results were graded by using Neer 100 units rating system. The rating system consists of 35 units for PAIN, 30 units for FUNCTION, 25 units for RANGE OF MOTION, 10 units form ANATOMY. CONCLUSION: In Osteoporosis where early rehabilitation is the key Locking Compression Plate is ideal. In large bone Locking Compression Plate offers higher weight bearing capacity than the conventional plates. An exact assessment of the severity of osteoporosis is important in allowing adequate treatment for associated pain and for decreasing the risk of future osteoporosis related fractures. In osteoporosis or poor quality bone bicortical engagement is recommended. Diaphyseal fractures of shaft of humerus in osteoporotic bone when treated surgically produce less pain, less stiffness and greater range of movement. Earlier the surgery better will be the results. In severely communited fractures where the anatomy cannot be restored without extensive soft tissue dissection, fixation with LCP gave better union and functional results. Results are best when operative method results in stable fixation that allows early passive mobilization