Evaluation of Functional Outcome Following Open Reduction and Internal Fixation of Proximal Humerus Fractures Using Philos Plate: A Prospective Study

Abstract

Original Research Article Proximal humeral fractures are the second most common fractures of the upper extremity and 20% of them require surgical fixation either because they needs better shoulder mobility or because their fracture is more severe. PHILOS plate promises to provide good fixation and stability. This prospective study aims to evaluate the functional outcome in the subjects following surgery. After obtaining due ethical clearance, a prospective study was conducted from January 2017 to September 2018. Thirty patients were selected. Fracture was classified using NEER'S Classification. All the fractures were approached by Delto pectoral approach and fixation done under fluoroscopic guidance. Patients were followed up at 6 weeks, 3, 6 and 12 months with radiographical evaluation and clinical examination and outcome. All patients at their final assessment underwent radiological and functional evaluation using the CONSTANT score. Based on NEER'S classification, 8patients (26.7%) had 2 part fracture, 12patients (40.0%) had 3 part fracture and 10patients (33.3%) had 4 part fracture. 1 patient had delayed union, 1 patient had non union, 2 patients developed stiffness of shoulder, 1 patient had a superficial infection and 1 patient had varus malunion. We assessed the final functional outcome with CONSTANT-MURLEY score and found that 7(20.0%) patients had excellent, 11(36.7%) patients had good, 7(23.3%) patients had moderate and 5(16.7%) patients had poor outcome. The mean constant score (mean± s.d.) of patients was 70.1000± 13.0816. Surgical management of fracture proximal humerus with PHILOS plating has a good functional outcome. However, proper patient selection, thorough knowledge of the anatomy and biomechanical principles are the prerequisites for a successful surgery.