Luaran Fungsi Klinis Fraktur Proksimal Humerus Pasca Reduksi Terbuka Fiksasi Interna pada Tulang Non Osteoporosis di RSUP Haji Adam Malik

Abstract

Introduction Proximal humeral fractures are complex injuries with significant morbidity. Treatment protocols are determined by bone quality, fracture pattern, degree of comminution as well as patient factors such as age and activity level and patient demand. Surgical options include closed reduction and percutaneous Kirschner pinning, fixation with transosseous sutures, open reduction and internal fixation with locking plates or conventional plates and hemiarthroplasty. With the limited results of studies describing the clinical function outcomes of proximal humeral fractures in open reduction with internal fixation using a proximal humerus locking plate, this study aims to determine the DASH Score clinical function outcomes of open reduction and internal fixation using the Proximal Humerus Locking plate in proximal humeral fractures. Methods This study is a cross-sectional study that assesses the clinical outcome of proximal humeral fracture treated with open reduction of internal fixation at Haji Adam Malik hospital from 2017 – 2023. Inclusion criteria were all patients diagnosed with proximal humerus fracture and undergoing open reduction surgery internal fixation using Proximal Humerus Locking plate, age 21-55 years, willing to become participants in the study after obtaining an explanation on a voluntary basis and patients who have undergone ORIF using Proximal Humerus Locking plate on the indication of proximal humerus fracture over 6 months when the DASH score assessment. The exclusion criteria of the study were patients with a history of having pathological fractures and running chemotherapy, patients suffering from post-operative infections and patients with primary or secondary Osteoporosis. Result In this study, the largest gender is female, as many as 8 samples (72.7%). At the age of the mean encountered in this study is 39.9 SD 16.38. Based on the fracture side found the most fracture side is the right as many as 6 samples (54.5%). In Neer classification, the largest group was Neer III, with 5 samples (45.4%). In the description of the average value of the DASH score after ORIF on the proximal humerus fracture obtained the best value of the DASH Score (Mean ± SD) obtained in the classification of Neer II is 14.15 ± 4.41. So it can be concluded that the severity of the fracture also affects the outcome of functional outcomes assessed using the DASH Score in patients with proximal humerus fractures performed ORIF action. Discussion In this study, it was found that the largest gender in this study was women, namely as many as 8 samples (72.7%). This is in accordance with the Iglesias-Rodríguez et al study in 2021 which examined the epidemiology of proximal humeral fractures found a prevalence of 77.6% in women with a ratio of 3.4:1 when compared to men. A statistically significant relationship was found between the age and sex variables (p <0.001). In this study, based on the post-open reduction DASH Score of internal fixation, the highest open reduction DASH score of internal fixation is a very good score of 6 samples (54.5%). Based on Richard et al (2020) it was found that the DASH score was the most widely used outcome measure at 31%. It takes into account daily activities, symptoms, and social functions/roles over the past week. The DASH score has been shown to have strong reliability and validity strong enough to assess patients with proximal humeral fractures. Conclusion Based on the results obtained, it can be concluded that patients aged <50 years have a better clinical function compared to patients aged >50 years, in the younger age group, men are more likely to experience proximal humeral fractures. While in the older age group, women have more proximal fractures of the humerus. A more numerous mechanism of injury in younger age groups is traffic accidents. While in the older age group is a fall slip.