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

Abstract

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

"Management of Neer Type of Humerus Fracture by Proximal Humerus Internal Locking System (Philos) Plate"

“…The functional outcome of the PHILOS in displaced proximal humeral fracture had 76% favorable and 24% unfavorable functional outcome [14]. Similar results were observed in another study conducted by Jabbar FA, et al [12] in which 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.…”

“…This descriptive case series study was conducted in Akber Medical Centre Ramdas Bazaar Peshawar Pakistan from August 2018 to February 2022 on total 71 patients of either gender of age more than 15 years. Using WHO sample size calculator, keeping 76% [12] prevalence of favorable functional outcome of the PHILOS plating measured based on Constant and Murley scoring system, 95% confidence level and 10% margin of error the sample size was 71. Non-probability Consecutive sampling Technique was used in our study.…”

“…The functional outcomes of the PHILOS are usually labeled by Constant and Murley scoring system [11]. Jabbar FA, et al [12], concluded that proximal humerus fractures treated with PHILOS plate has good favorable functional outcome in all the patients at final follow up. Neer has classified the fracture for management and prognosis purposes in four parts which is the worst type.…”

Frequency of Acute Compartment Syndrome in Closed Fractures of the Limbs

“…In our study, Excellent functional outcome was seen in 21.9%, good 36%, fair 33.3% and poor was 8.8%. In a study by Jabbar FA, et al has shown that frequency of excellent functional outcome was 54%, good 24%, fair 14% and poor was 8% after proximal humerus fracture fixation using PHILOS system [9]. In another study by Rao NN, et al has shown that frequency of excellent functional outcome was 4%, good 44%, fair 44% and poor was 8% after proximal humerus fracture fixation using PHILOS system [10].…”

“…PHILOS plate provides rigid fixation, more angular stability and early mobilization. There is variability in results when PHILOS system is used in different populations as shown in above studies [9,10]. Therefore further evidence is needed to evaluate the functional outcomes of proximal humeral internal locking system in treatment of proximal humerus fractures.…”