Functional outcome of proximal humeral interlocking system plating for displaced proximal humeral fractures in adults

Abstract

Objective: The objective of the study was to assess functional outcome of Proximal Humerus Inter Locking System (PHILOS) Plating in displaced proximal humeral fractures by Constant-Murley (Subjective and Objective) score. Material and methods: The PHILOS plate was used for internal fixation of displaced proximal humeral fractures in 25 patients 11 females, 14 males; mean age 60.64 years range(28-90yrs). Fractures were caused by low-energy trauma fall from standing height in 16 patients, and by an road traffic accident in 9 patients. Involvement was on the right in 15 cases and on the left in 10 cases. Bone graft was used in 2 cases to prevent varus malalignment. All patients received a similar physical therapy program following internal fixation with the PHILOS plate. The patients were assessed clinically and radiographically at regular intervals of 6 weeks, 12 weeks and 6 months. Functional outcome was assessed using the Constant- Murley score. Complications during the follow-up period were recorded. Results: 9 patients had Neer’s four part fracture, 12 patients had 3 part fracture and 4 patients had 2 part fracture. After 6 months of follow up mean Constant and Murley score of 63.76 was achieved. Outcomes were excellent, good, moderate and poor in 2(8%), 3(12%), 14(56%), 6(24%) respectively. The most frequent complication seen was shoulder stiffness in 6 patients, malreduction in 4 and impingement in 4 patients.Conclusion: Fixation of proximal humerus fractures with proximal humerus locking plates is associated with satisfactory functional outcomes in 2-part and 3-part and 4 part fracture. The incidence of complications is relatively high in 3 part and four part fractures. Advanced surgical skills and surgeon’s experience are considered to be more critical for successful operative treatment.