Results of surgical management of displaced or complex proximal humeral fractures with proximal Humerus internal locking system: A prospective study of 55 cases

Abstract

Background: The optimal treatment of proximal humeral fractures remains always challenging and controversial. The purpose of this prospective study was to evaluate the functional outcome of proximal humerus internal locking system (PHILOS) plate fixation for displaced or complex proximal humeral fractures and to establish the influencing factors of an unfavourable outcome. Materials and Methods: After obtaining approval from institutional ethics committee, 55 patients with the displaced proximal humeral fractures were managed by open reduction and PHILOS plate fixation through delto-pectoral approach and as per standard protocol. The results of follow-ups were analysed radiologically and clinically, using the “Constant and Murley scoring system” at once in a month for first three months, once in three months for next six months and once in six months thereafter upto 2 years post-operatively. Results: In the present study, out of 55 patients, clinical results were excellent in 50.9%, good in 21.8%, fair in 16.4% and poor in 10.9% patients. Radiological union was achieved in all patients, including two cases of mal-union and one case of delayed union. Post- traumatic frozen shoulder (7 cases), secondary arthritis (5 cases), secondary screw penetration (3 cases), and AVN humeral head (3 cases) were the main complications observed in this study during 2 years of follow-ups, which were treated accordingly. Conclusion: Pre-contoured PHILOS plate preserves shape of humeral head, provides angular stability, facilitates to restore the medial column and prevent secondary varus collapse in severe comminuted and osteoporotic proximal humeral fractures. With proper patient selection, PHILOS plate provides favourable clinical and radiological outcome with acceptable complication rates.