OUTCOME OF PROXIMAL HUMERUS FRACTURES TREATED BY PHILOS PLATE INTERNAL FIXATION–A DISTRICT GENERAL HOSPITAL EXPERIENCE

Abstract

Aim: To assess the clinical and functional outcome of proximal humeral fractures (2,3 and 4 parts) fixation with PHILOS (Proximal Humeral interlocked Osteosynthesis) plate using Oxford and DASH scoring system.

Methods: Forty-eight consecutive patients were treated with PHILOS plate from the complex proximal humeral fractures. One senior surgeon, using PHILOS plates, operated all patients. The patients were regularly assessed clinically, and plain radiographic evaluation was performed for fracture healing, avascular necrosis, and implant failure. Clinical outcome was measured using Oxford shoulder scores and DASH (Disability of the arm, shoulder, and hand) scores. Patients, who died, lost the follow up or the follow up was less than 3 months were excluded from the study.

Results: There were nine male patients (Age: 29–89 yrs) and twenty-nine female patients (Age: 35–93 yrs). Average age: 65 yrs. 74% were two part and three part fractures. Five patients died and four were lost in follow-up. These patients were excluded from the study. Mean follow-up time: 21.7 months (range: 6–44 months). Mean oxford shoulder scores: 41.8 (range: 14–60), Mean DASH scores: 30.2 (range: 0–83.3). There were no cases of non-union. Two plates were removed after fracture healing for complications of impingement and screw cutout.

Discussion & conclusion: Proximal humeral fractures constitute 5–7% of all fractures and 26% of humeral fractures.13–16% of proximal humeral fractures are 3 & 4 parts. Proximal humeral fractures have been a challenge to acquire stable fixation. Difficulties have been multifactorial, including osteoporotic bone, angular instability and non-availability of the low-profile implant to avoid impingements. PHILOS plate having locking screws provides angular stability and better hold in osteoporotic bone. It is low profile, which avoids subacromial impingement. Multiple holes in the proximal part of plate for suture anchors helps for soft tissue augmentation. PHILOS plate can provide an excellent stable construct even in multifragmented Osteoporotic proximal humeral fractures.

Our study has shown that PHILOS plates are reliable implants for internal fixation of proximal humerus fractures. An inverse correlation was seen between oxford shoulder scores and DASH scores. Patients with higher oxford scores indicating a good outcome had lesser disability scores. Comminuted fractures (four part fractures) had less than satisfactory shoulder scores and higher disability scores. In general, younger patients did better than older patients. This study demonstrates that PHILOS plates provide stable internal fixation for proximal humerus fractures. Age and fracture configuration play a significant role in the clinical outcome of these fractures after internal fixation.