Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system

Moonot, Pradeep; Ashwood, Neil; Hamlet, Mark

doi:10.1302/0301-620x.89b9.18528

Cited by 186 publications

(174 citation statements)

References 19 publications

(26 reference statements)

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“…15,16,17 In our study we utilized the deltopectoral approach in the patients of the proximal humerus fractures, the important points that must be taken care of are the placement of the plate of proper length, using the fluoroscopic imaging when placing the screws in the correct position and avoiding the varus displacement by ensuring support to the medial side of the cortex. 18,19,20 The overall complication rate in our study was found to be 18% and 10% of the patients had varus malunion, while the remainder of the complications were impingement, infection, failure of fixation and intra articular screw, revision surgeries were performed for the patients with deep infection and failure of fixation. In the study by Egol et al they had an infection rate of 1.61% in their case series and similar rate of observed in a study by Moonot et al and Gardner et al, in which the patients of infection were treated with antibiotics only.…”

Section: Discussionmentioning

confidence: 52%

Proximal Humerus Fractures; Radiological and Functional Outcome as Treated With the Philos Plating System, at a Tertiary Care Centre in Karachi, Pakistan.

Jabbar¹

2017

TPMJ

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ABSTRACT… Objectives:The aim of our study is to study the radiological and functional outcome of proximal humerus fractures treated via open reduction and internal fixation using the proximal humerus internal locking system or PHILOS. Study Design: Case series study. Period 05 years duration from January 2011 to December 2015. Setting: Large tertiary care centre in Karachi, Pakistan. Materials and methods: The study population consisted of n=50 patients all of whom underwent open reduction and internal fixation utilizing the proximal humeral internal locking system or PHILOS for fractures of the proximal humerus. The inclusion criterion was all the patients with closed fractures of the proximal humerus and were belonging to 2,3 and 4 part of the Neer system of classification. Physiotherapy was started as soon as possible for the patients. Serial radiographic imaging in two views was done at 6, 12, 24 and 52 weeks postoperatively. For the functional outcome of the procedure Constant and Murley scoring system was used. Data was analyzed using IBM SPSS version 21. Results: The study population consisted of n= 50 patients of which n= 35 were males and n= 15 were females having a mean age of 38.50 years. The mean duration of follow up was 24 months. All the patients in the study had union of fracture both radiographically and clinically, the mean time duration for the radiographically evident union of the humerus bone was 12 weeks with a range of 8 to 20 weeks, the mean Constant Murley score for the functional outcome of the shoulder joint was 79 at the final follow up with a range of 50 to 100. Complications were found in n= 9 patients and varus malunion was the most common complication. In our case series we did not observe complications such as avascular necrosis, non union or implant failure. Conclusion: According to the results of our study the proximal humerus internal locking system or PHILOS is a good method for open reduction and internal fixation of the proximal humerus fractures and provides a stable fixation, and has lower incidence of complications such as avascular necrosis. Key words:Humerus fractures; Open reduction internal fixation; Proximal humerus internal locking system; PHILOS; Surgical outcome. Article Citation: Jabbar FA, Shah RA. Proximal humerus fractures; radiological and functional outcome as treated with the philos plating system, at a tertiary

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Section: Discussionmentioning

confidence: 52%

Proximal Humerus Fractures; Radiological and Functional Outcome as Treated With the Philos Plating System, at a Tertiary Care Centre in Karachi, Pakistan.

Jabbar¹

2017

TPMJ

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“…Older age and requiring revision surgery were mentioned as the most predictive factors yielding undesirable outcome. Two other reports from early experiences by Moonot & Koukakis [9,10] have also provided valuable information with almost similar outcomes. In the study by Moonot, it was mentioned that good bone density permits early post-operative mobilization of upper extremity.…”

Section: Discussionmentioning

confidence: 77%

“…The Proximal Humeral Internal Locking System (Philos®) plate has specifically been designed to provide stability in proximal humeral fractures. It can be applied with a minimally invasive method and has screws which are placed in converging and diverging directions [9]. Several holes in the proximal part of the plate function as suturing anchors to the rotator cuff.…”

Section: Introductionmentioning

confidence: 99%

A Report on Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

Azizian¹

2017

MOJCSR

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Background: Proximal humeral fractures are among prevalent types of fractures and remain a challenging issue for surgical management. This study aimed to assess the clinical outcomes and complication rates of three-vs. four-part proximal humeral fractures, treated with internal fixation using the Philos® plate. Material and Methods:In this cohort study, a total of 30 consecutive patients with three-part or four-part proximal humeral fractures based on the Neer classification were included. Surgical treatment was performed with open reduction and internal fixation using the Philos® plate. Constant score was evaluated 6 months later in follow-up. P-value <0.05 was considered significant.Results: Four-part fractures were mainly caused by a trauma from above, while insults of opposite direction were responsible for more than half of 3 part fractures (P-value=0.010). Open fractures were only observed in patients with four-part fracture (P-value=0.018). No significant differences were noticed regarding gender, cause and side of fracture. Presence of other fractures, fracture of implant, reduction loss, avascular necrosis (AVN) of humerus head, rotator cuff injury, and revision surgery were significantly higher in patients with four-part fractures. Constant score was 81.40±11.61 and 65.09±16.09 for three-part and four-part fractures, respectively (P-value=0.006). Conclusion:Open reduction and internal fixation with Philos® plate yields acceptable results in both types of fractures, however prognosis of this intervention is poorer four-part fractures.

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“…Our study has similar results compared with other studies of surgical management of the proximal humerus. 25,[30][31][32][33][34][35][36] Proximal humerus fractures occur more commonly in the middle age group. Numerous age-related studies point toward this, and our study is consistent with this finding.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcome of Locking Compression Plate in Neer's two-part, three-part, four-part Proximal Humerus Fractures

Ramesh¹,

Goel²,

Kiran³

et al. 2016

The Journal of Medical Sciences

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Introduction Proximal fractures of the humerus account for about 4 to 5% of all fractures. They are the most common fractures in elderly population. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains challenging. Objectives The present study is undertaken to evaluate the functional outcome of proximal humerus fractures treated by locking compression plate in 20 patients. Materials and methods Prospective study was done involving 20 adult patients with proximal humerus fractures admitted from October 2012 to December 2013 treated by open reduction and internal fixation (ORIF) with locking compression plate. The functional follow-up was done for a minimum period of 3 months and the patients were evaluated by Constant Murley scoring (CMS). Results In our series, the majority of the patients were middle-aged males, with road traffic accidents (RTAs) being the most common cause of injury, involving 2-part, 3-part, and 4-part fractures of the proximal humerus. The fractures were united in 19 patients and 1 patient had avascular necrosis (AVN). Excellent results were seen in 15% of patients, good results in 55%, moderate results in 15%, and poor results in 15% according to CMS. There were 95% union rates, 5% of AVN, and no failures. Conclusion In conclusion, locking compression plate is an advantageous implant in proximal humerus fractures due to angular stability, particularly in comminuted fractures and in osteoporotic bones of elderly patients, which allows their early mobilization. How to cite this article Mahesh G, Kiran KC, Ramesh KV, Kumar R. Functional Outcome of Locking Compression Plate in Neer's two-part, three-part, four-part Proximal Humerus Fractures. J Med Sci 2016;2(1):1-8.

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Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system

Cited by 186 publications

References 19 publications

Proximal Humerus Fractures; Radiological and Functional Outcome as Treated With the Philos Plating System, at a Tertiary Care Centre in Karachi, Pakistan.

Proximal Humerus Fractures; Radiological and Functional Outcome as Treated With the Philos Plating System, at a Tertiary Care Centre in Karachi, Pakistan.

A Report on Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

Functional Outcome of Locking Compression Plate in Neer's two-part, three-part, four-part Proximal Humerus Fractures

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