Study of proximal humerus fractures treated with proximal humerus interlocking system (Philos) plating

Abstract

Introduction: Proximal humerus fractures are common and debilitating injuries, especially in elderly as osteoporosis and deforming forces of muscle attached. Wide range of treatment modalities ranging from conservative management to shoulder arthroplasty. In our study we have evaluated proximal humerus interlocking osteosynthesis (PHILOS) plate in displaced and comminuted fracture due to its rigid construction, angular stability and early post- operative rehabilitation. Objective of Study: The objective of study 1) To evaluate and analyze the functional outcomes of PHILOS plate for displaced fractures of proximal humerus 2) To improve stability in osteoporotic humeral bone 3) To preserve the biological integrity of the humeral head and to secure an anatomical reduction with multiple locking screws with angular stability 4) To study the complication rates of PHILOS plating in proximal humerus fractures Methodology: A prospective study of treatment of proximal humerus fractures treated with PHILOS plate was carried out at our institute, at the Department of Orthopaedics, S.S.G. Hospital Vadodara from June 2017 to august 2018, where after applying exclusion and inclusion criterion, 20 patients of proximal humerus fractures were included in our study. Fractures were classified as per NEER’S classification. Assessment of union, movements at shoulder, constant score and complications were done during regular follow-up of 5 month. The functional outcome was measured using Constant and Murley Shoulder Scoring System. Results: In present study, after clinical and radiological assessment after 5 months follow-up, mean Constant and Murley score of 84.85 was achieved.9 patients (45%) had excellent result with score more than 90 and 7 (35%) patients had good result with score more than 80, 2 patients (10%) had fair result with score more than 70. 2(10%) patients had poor results with score less than 70 may be due to with medial cortical comminution and osteoporosis in which malreduction and shoulder stiffness are most frequent complication. Conclusions: The divergent and convergent orientation of the locking screws of PHILOS plate provides stable biological fixation with high union rate to use for treatment of fractures of the proximal humerus in Neer’s 2-part, 3-part, and 4-part with better functional and radiological outcome especially in osteoporotic bone due to low complication and early postoperative mobilization. Potential minimal complication can be prevented by advanced surgical skill and expertise and rotator cuff tying.