The functional outcome of direct lateral approach for fixation of proximal humeral fractures: A case series from a tertiary care hospital.

Displaced proximal humeral fractures warrant surgical fixation for early rehabilitation and better functional outcome. These fractures are traditionally fixed by delto pectoral surgical approach. Direct lateral approach has recently gained interest as it involves less soft tissue dissection and is particularly helpful in certain fracture patterns. However, there have been concerns of axillary nerve damage with this approach. We report a case series of proximal humerus fractures fixed by direct lateral approach from our institution. All displaced Type 2 and 3 fractures were included in our study. Pathological and comminuted Type 4 fractures and fractures with ipsilateral clavicle or elbow fractures were excluded. Oxford Shoulder Score was done at regular intervals for assessment of functional outcome. We did not observe any axillary nerve damage in our case series and the outcomes of 70.5% of our patients were excellent while in 29.5% it was good. We recommend direct lateral approach for specific pattern of proximal humerus fractures.

Management Outcomes Of Extra Abdominal Fibromatosis Among Adult Patients Treated At A Tertiary Care Hospital.

BACKGROUND: Aggressive fibromatosis or desmoid fibromatosis is a soft tissue neoplasm which is non-metastatic in nature. Among all soft tissue tumours, it comprises of 3% cases and is more common in females as compared to males. Objective of our study was to evaluate the treatment outcomes of extra abdominal fibromatosis in patients who were treated in our setup and determine the recurrence patterns. METHODS: It is retrospective cohort of 15 patients that were treated in section of Orthopaedics, department of surgery, Aga Khan University hospital, Karachi from January 1990 to December 2015. It included all adult patients of age >18 years with biopsy proven extra abdominal aggressive fibromatosis. Data was analysed on SPSS 22 version.. RESULTS: Out of 15 patients, there were 7 males (46.7%) and 8 females (53.3%). Median age was 22 years. Majority of patients [10 (66.6%)] had upper limb lesion. On initial biopsy we had 11 (73.3%) cases of primary fibromatosis while 2 (13.3%) were recurrent and 2 (13.3%) were spindle cell carcinoma. The median (IQR) follow-up time of the participants was 3 (2-3) months. Complications occurred in 8 (53.3%) patients. A significant difference was observed in the haemoglobin levels before and after surgery with a mean difference of 2.74 (p-value<0.001). Recurrence of disease occurred in 4 (26.7%) patients and all of these patients who had recurrence underwent 2nd surgery versus 1 of the participants who had second surgery without recurrence and this was a significant difference (p value <0.004). CONCLUSION: Extra abdominal fibromatosis is commonly found among younger age groups, affecting females more as compared to males. Less than half of the patients had recurrence of disease in our study and intra-operative and postoperative complications are common surgical outcomes and our study results are compatible with previously reported literature.