Study of surgical management of fracture of proximal humerus by PHILOS plate and screws
Keywords:Proximal humerus, PHILOS plate, Constant and Murley score, DASH score
Background: Proximal humerus fracture accounts for about 5% of all fractures in recent advances proximal humerus fractures are often managed operatively with PHILOS plate which provides greater angular stability and study was aimed at to assess functional outcome of PHILOS plate fixation in proximal humerus fractures.
Methods: Prospective study of 31 cases of proximal humerus fractures admitted and operated in Kempegowda Institute of Medical Sciences Hospital November 2017 to May 2019 of which 4 patients died due to medical comorbidities so 27 patients were studied. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Constant and Murley (CM) scoring and disabilities of the arm, shoulder and hand (DASH) scoring.
Results: CM scoring and DASH scoring was applied to analyze the functional outcome among the cases. Most of the patients had excellent outcome (52%) followed by good (26%), fair (8%) and poor (15%) outcome according to CM scoring and according to DASH scoring 20.21 was mean score and mean CM score was 77.62. Complications observed were impingement in 1 patient, avascular necrosis in 2 patient and non union in 1 case.
Conclusions: We conclude that the use of PHILOS plate for the fixation of proximal humerus fractures is a good device as it provides rigid fixation and early mobilisation and prevented complications. Precontoured locking plates work on the principle of angular stability, divergent screws, less disruption of vascularity and less chances of plate failure.
Court-Brown C, Garg A, McQueen M. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-71.
Handoll H, Gibson J, Madhok R. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2003(4):CD000434.
Court-Brown C, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7.
Kumar C, Gupta AK, Nath R, Ahmad J. Open reduction and locking plate fixation of displaced proximal humerus fractures. Indian J Orthop. 2013;47(2):156-60.
Lanting B, MacDermid J, Drosdowech D, Faber K. Proximal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg. 2008;17(1):42-54.
Murray IR, Amin AK, White TO, Robinson CM. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br. 2011;93(1):1-11.
Martinez AA, Cuenca J, Herrera A. Philos plate fixation for proximal humeral fractures. J Orthop Surg (Hong Kong). 2009;17(1):10-4.
Helmy N, Hintermann B. New trends in the treatment of proximal humerus fractures. Clin Orthop Relat Res. 2006;442:100- 8.
Kiliç B, Uysal M, Cinar BM, Ozkoç G, Demirörs H, Akpinar S. Early results of treatment of proximal humerus fractures with the PHILOS locking plate. Acta Orthop Traumatol Turc. 2008;42(3):149-53.
Bjorkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with alocking compression plate: are trospective evaluation of 72 patients followed for aminimum of 1 year. Acta Orthop Scand. 2004;75:741-5.
Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res. 2006;442:115-20.
Neer CS. Displaced proximal humeral fractures.I: classification and evaluation. J Bone Joint Surg[Am]. 1970;52:1077-89.
Constant CR, Gerber C, Emery RJ, Søjbjerg JO, Gohlke F, Boileau P. Are view of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008;17(2):355-61.
Gerber C, Schneeberger AG, Vinh TS. The arterial vascularization of the humeral head. J Bone Joint Surg 1990;72:1486-93.
Aggarwal S, Bali K, Dhillon MS, Kumar V, Mootha AK. Displaced proximal humeral fractures: an Indian experience with locking plate. J Orthop Surg Res. 2010;5:60.
Jose TM, Vincent TA and George Paul A. Evaluation of the Outcome of Proximal Humerus Fracture Managed By Internal Locking Plate- A Prospective Study. IOSR J Dent Med Sci. 2017;16(5):36-43.
Gracitelli MEC, Lobo FL, Ferreira GMA, da Palma MV, Malavolta EA, Benegas E, et al. Outcomes evaluation of locking plate osteosynthesis in displaced fractures of the proximal humerus. Rev Bras Ortop. 2013;48(6):491-9.
Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complication of proximal humerus fractures treated with locked plates. J Orthop Trauma. 2008;22:159-64.
Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg Br. 2007;89(9):1206-9.