Management and early outcome of proximal humeral fractures at Muhimbili Orthopaedic Institute (MOI)

Background: Proximal humeral fractures with a dual age distribution occurs either in young people following high energy trauma or in elderly with low velocity injuries like simple falls. Three fourths of the fractures occur in older individuals with an occurrence three times more often in women than in men. These fractures can be treated non-operatively or operatively depending on bone quality, fracture pattern, degree of comminution as well as patient factors such as age and activity level. Objective: To study the management of proximal humeral fractures and their outcome. Methodology: A descriptive, observational, cross section hospital based study was carried out on 58 patients with proximal humeral fractures managed at Muhimbili orthopedics Institute (MOI) from March 2015 to February 2016. Data were obtained using structured questionnaire, radiological examination and physical examination on admission and during follow up visits. During the 4th, 8th, 12th week post treatment, functions were assessed using constant shoulder score and documented. Results: In this study 58 patients who met the inclusion criteria and completed the follow up weeks were studied, majority, 41 (70.7%) were female and 17 (29.3%) male, Female: male ratio 2.4:1. The Proportional of proximal humeral fractures was 4.6% of all appendicularskeleton fractures, and falling from same level was found to be the most common cause of injury. More than half of the patients 35(60.3%) were aged more than 60 years. The median age was 62 years (range of 19 to 83years). Majority(67.2%) had undisplaced/minimally displaced fracture and were managed non operatively. Only 7(12.1%) were operated due to limited surgical options. Out of all patients studied 17(29.3%) had mal union, more than half 33(56.9%) of patients had no complication. Conclusion: Proximal humeral fractures at MOI are not uncommon (4.6%of all appendicular fractures) affecting females more than males and occur commonly in those aged more than 60years. The operation rate is low with mal union and poor shoulder function being the common complication at 12th week