A comparative study between functional outcomes of proximal humerus fracture treated using closed reduction and JESS external stabilization system and open reduction and internal fixation with PHILOS plate at a tertiary health care center

Introduction Proximal humerus fractures account for 5 % of all fractures. Their incidence increases with age, especially in women over 60. Most of them (85 %) are minimally displaced and managed non-operatively, while 15 % require surgery. Neer’s classification guides treatment, which includes conservative methods and operative methods. The operative techniques are PHILOS plating, pinning, nailing, or arthroplasty. The JESS fixator, developed by Dr. B.B. Joshi, offers a minimally invasive alternative.

Purpose To compare the functional results of proximal humerus fractures treated with PHILOS plating and JESS fixation.

Material and method The prospective observational study was conducted over 24 months on 36 patients with proximal humerus fractures. Patients were divided into two groups, 18 in each group, based on the surgical technique used: JESS fixation and PHILLOS plating. JESS group had more females, while PHILOS had more males. The Constant – Murley Scores were used to compare the functional outcome in both groups at regular intervals. Complications of both techniques were assessed.

Results Falls were the main cause in JESS (72.22 %), while road accidents were more common in PHILOS (55.55 %) group. Both groups showed significant improvement in Constant – Murley Scores (p < 0.005). JESS group had one case each of avascular necrosis, malunion, and pin tract infection. PHILOS group had one implant failure and one avascular necrosis case, both managed effectively.

Conclusion In the management of proximal humerus fractures, JESS fixation and PHILOS plating are equally effective. This study also led us to the conclusion that JESS fixation for proximal humerus fractures is a semi‑rigid, inexpensive technique that permits early mobilization, needs few implants, requires a short hospital stay and surgical period, resulting in good to excellent functional results with a minimal risk of complications.

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