Proximal humerus locking plate fixation for proximal humerus fractures

Abstract

Objective: To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal Humerus fractures. Methods: We reviewed 20 patients who underwent open reduction and internal fixation with PHILOS plate from June 2012 to June 2013. There were 16 men and 4 women with a mean age of 45.01 years (range 41-50). There were 9 patients in the age group of 40 years. According to Neer classification system, 7, 12 and 1 patients had 2-part, 3-part, and 4-part fractures, respectively. All surgeries were carried out at tertiary care Hospital. Functional evaluation of the shoulder at final follow-up was done using Constant score. Results: The mean follow-up period was 18 months (range 12-36 months). Three patients were lost to follow-up. Of the remaining 20 patients, all fractures were united clinically and radiologically. The mean time for radiological union was 90 days {12 weeks (range 8-20 weeks)}. At the final follow-up the mean Constant score was 67.25 (range 50-100). The results were excellent in 7 patients, good in 7 patients, fair in 5 patients and poor in 1 patient. During the follow-up, one case of varus malunion, four cases of stiffness and five cases of abductor weakness were noted. No cases of avascular necrosis, hardware failure, locking screw loosening or non-union, failure of fixation were noted. Conclusion: PHILOS provides stable fixation in proximal Humerus fractures. To prevent potential complications like avascular necrosis, meticulous surgical dissection to preserve vascularity of humeral head is necessary.