Does Proximal Humerus Inter Locking System (PHILOS) Plating Provide a Good Functional Outcome in Proximal Humerus Fractures?

Abstract

IntroductionThere is still a lot of controversy and ambiguity, and no single therapy regimen or strategy for proximal humerus fractures has been proved to be uniformly helpful. According to estimates, only about 20% of proximal humeral fractures require surgery. This study aims at evaluating the functional outcome of treatment of Proximal humerus fractures with PHILOS (Proximal Humerus Inter Locking System) plating using Constant score and assessing the duration for fracture union by follow-up x-rays. MethodologyThis is a retrospective study on patients admitted to the Department of Orthopaedics attached to a tertiary hospital in Kolar from January 2017 to January 2020. After meeting inclusion and exclusion criteria, 40 patients were included in this study. All the patients underwent PHILOS plating after the pre-anesthetic check-up. The patients were regularly followed up, the functional outcome was assessed using the Constant Murley score, and the fracture union was assessed radiologically by follow-up x-rays. ResultsThe mean age of our forty patients was 46.8 (20-70), with a male: female ratio of 2.3:1. Fractures united at an average of 13.75 weeks. The functional outcome was found to be excellent in 2 patients (5%), good in 22 patients (55%), fair in 7 patients (17.5%), and poor in 9 patients (22.5%). The Constant mean score achieved was 68.75±14.03. The mean time of fracture union was 13.75 weeks. The constant score was compared between variables like age groups, sex, fracture pattern, and mode of injury, but the values were statistically insignificant. ConclusionEven in individuals with osteopenic bones, we achieved excellent to good fracture repair in most cases. The locking plate provides adequate fracture stability and facilitates early shoulder mobilization without hindering fracture union.

Outcome of Neer Type 3 & 4 Fractures of Humeral Head Treated with Proximal Humerus Internal Locking System (PHILOS) Plate Osteosynthesis

“…In our study, the mean operative time was 59.57±19.39 minutes (ranging 45-120 minutes). In a study reported by Leonard et al, mean operative time was 81 minutes (ranging 60-123) 13 . In our study, the mean constant score was 72.76±12.25 with a range from 0-100 score.…”

“…This aim is achieved by multi-directional locking screws for the head, pre-contouring of plate as well as locking screws in 3 & 4 part PHF 12 . Some researchers have observed that PHILOS plate resulted in good outcomes in treating patients with displaced 3 and 4-part PHF, and quite stable fixation is achieved which allows early mobilization [13][14][15] . Our study showed that the PHILOS plate results in excellent and good results in treatment of PHF Neer type 3 & 4.…”

Intramedullary Nail for Treatment of Proximal Humeral Fracture: A Credible Fixation in Comminuted Calcar

“…There are a number of fixation techniques, such as tension‐band routing, locking plate fixation, and intramedullary nailing over the past decade 8–14 ; however, no single technique demonstrated evidence‐based superiority. Although locking plate fixation is considered as the standard treatment, complication rates are still unsatisfactory 15–20 . One of the major complications of surgical management in the elderly is secondary varus displacement associated with fixation failure due to screw cut‐out or cut‐through 21 …”

“…Although locking plate fixation is considered as the standard treatment, complication rates are still unsatisfactory. [15][16][17][18][19][20] One of the major complications of surgical management in the elderly is secondary varus displacement associated with fixation failure due to screw cut-out or cut-through. 21 Recent studies have discussed that the restoration of medial support has an important impact on clinical outcome and it is accomplished by cortical anatomical reduction, or placement of calcar screws.…”

“…Although locking plate fixation is considered as the standard treatment, complication rates are still unsatisfactory. 15 , 16 , 17 , 18 , 19 , 20 One of the major complications of surgical management in the elderly is secondary varus displacement associated with fixation failure due to screw cut‐out or cut‐through. 21 …”