FIXATION OF THREE- AND FOUR-PART PROXIMAL HUMERUS FRACTURES USING THE PHILOS PLATE: EARLY EXPERIENCE.

Abstract

Fractures of proximal humerus account for nearly 5% of all fractures. Majority of these fractures are minimally displaced and can be treated non-operatively with good functional results. However, treatment of unstable, displaced and comminuted fractures remains a challenge and optimal treatment continues to be controversial.

This study was undertaken to evaluate the results of proximal humeral internal locking system (PHILOS) plating done for treatment of displaced three- and four-part fractures of the proximal humerus.

Between November 2003 and February 2008, a total of 36 patients with displaced three- and four-part fractures of the proximal humerus had an open reduction and internal fixation using a PHILOS plate.

Data was collected retrospectively and clinical and radiological outcomes were assessed.

The mean follow up was 18 months. 35 (97.2%) united clinically and radiologically, with a mean neck/shaft angle of 127.1 degrees. One patient (2.8%) had revision procedure for implant failure, with a longer PHILOS plate and bone graft. The mean time to union was 9 weeks (7 to 20). The mean Constant score at final review was 72.1 (36 to 96). A total of 16 patients (44.4%) had excellent outcome, 16 (44.4%) had satisfactory outcome, but in four (11.2%) the outcome was poor.

The PHILOS plate provides good fracture stability early-on allowing early mobilisation without compromising fracture union. It requires minimal soft tissue dissection, does not need contouring and angular screw fixation gives good stability. We stress the importance of minimal soft tissue dissection to preserve the vascularity of the head, indirect methods of reduction and early mobilization.