Functional outcome and incidence of avascular necrosis after two years in four part proximal humeral fractures treated by proximal humerus internal locking system

Background: The management of proximal humerus fractures (PHF) is a challenging task to any surgeon. Study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system in fixation of displaced proximal humeral fractures.Methods: Study was conducted in the Department of Orthopedics, GSL Medical College. Informed written consent was taken from the study participants. All skeletally mature patients aged >18 years, presenting with displaced PHF according to Neer two, three and four part fracture were included in the study. Either deltopectoral or deltoid splitting approach was used for surgery, post-operative rehabilitation was started on day one.Results: Twenty-five patients with PHF were enrolled in the study; five-holed proximal humerus locking plate (PHLP) was used for 18 patients, eight-holed PHLP for 05 and three-holed, ten-holed PHLP for 01 for one each. The Constant-Murley score was significantly improved (p=0.000) over each successive follow-up period with the average improvement of around 19 scores between 1st and 2nd follow-up and around 15 score improvement between 2nd and 3rd follow-up.Conclusions: The proximal humeral locking plate is an adequate device for the fixation of displaced two-part, three-part and four-part PHF. Patient can regain good shoulder function, resume normal activities much earlier.

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Assessment of functional outcome of surgical management of proximal humerus fracture treated with PHILOS plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20183673 ◽

2018 ◽

Vol 4 (5) ◽

pp. 736

Author(s):

Jairam D. Jagiasi ◽

Mihir R. Patel ◽

Sagar G. Daliya ◽

Amol Bochare ◽

Manan Vora

Keyword(s):

Functional Outcome ◽

Scoring System ◽

Proximal Humerus ◽

Plate Fixation ◽

Surgical Techniques ◽

Functional Results ◽

Operative Management ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Philos Plate

Background: Proximal humeral fractures were treated conservatively in the past and often had compromised functional results. With the advancement of surgical techniques, these fractures, especially displaced, are now more often managed operatively; to meet the needs of the patient, provide early rehabilitation and better functional outcome. The aim of this study was to assess the functional outcome of operative management of proximal humeral fractures with Philos plate fixation.Methods: In this prospective study, 30 patients aged 19-75 years (mean age 47.1 years) with fractures of the proximal humerus, including two-, three-, and four-part fractures, were treated by open reduction internal fixation with Philos plating. Patients’ functional outcomes were evaluated based on subjective (35 points) and objective (65 points) parameters, as per the constant scoring system.Results: Functional outcome based on the constant scoring system of the patient at 6 month follow-up were compared. Excellent results were seen in 12 patients (40%), 2 had very good results (6.66%), 9 patients were having good (30%) and 6 had fair (20%) functional outcome. One patient had poor functional results (3.33%). Avascular necrosis (AVN) of the humeral head was observed in one patients.Conclusions: Philos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and is a feasible option.

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Radiological correlation with functional outcome in displaced proximal humerus fractures treated with locking plates: a prospective study of 35 cases

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20181801 ◽

2018 ◽

Vol 4 (3) ◽

pp. 471

Author(s):

Neetin Pralhad Mahajan ◽

Nikhil Dilip Palange ◽

Eknath D. Pawar ◽

Hitesh Jivrajbhai Mangukiya ◽

Ujwal Suryabhan Ramteke ◽

...

Keyword(s):

Prospective Study ◽

Functional Outcome ◽

Proximal Humerus ◽

External Rotation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plates ◽

Range Of Movement ◽

Maximum Improvement

Background: The objective of this prospective study is to investigate the relationship between the functional outcome and the radiographic results of two-, three- and four part proximal humeral fractures treated with open reduction and fixation with PHILOS locking plate.Methods: 35 patients (30 males and 5 females) with displaced proximal humerus fracture were treated with PHILOS plating and studied prospectively. According to Neer’s classification there were 16 two part fracture (45%), 15 three part fracture (42%) and 4 four part fracture (13%). The healing of fracture, head shaft angle (HSA) and complications were evaluated radiologically with plain radiographs whereas the functional outcome was assessed by the Shoulder Pain and Disability Index (SPADI) at 6 weeks, 3 months, 6 months and 1 year after surgery.Results: In our study, patients treated with locking plates had mean forward flexion of 123°, abduction of 124°, mean external rotation of 30° and internal rotation 53° at 1 year follow-up. Maximum improvement in range of movement occurred between interval of 12 weeks to 24 weeks due to complete fracture union occurred approximately up to 12 weeks. The mean SPADI score at end of 1 year were 10.22, 10.38 and 10.20 for two, three and four part fractures respectively. Average postoperative and follow-up HSA's were 134.1±4.4 and 132.5±1.2 degrees, respectively. Varus progression was more prominent in patients with postoperative HSA <130 (p<0.001). Complications included impingement in 1 case, joint penetration by screw in 1 case, failure of fixation in 1 case and infection in 1 case.Conclusions: Fixed angle locked plate is an extremely useful implant for reconstruction and salvage of proximal humeral fractures. Precise surgical technique, stable fracture fixation and restoration of anatomical reduction are absolutely necessary for improved outcome.

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Outcome analysis of patients with proximal humerus fractures treated with locking plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171578 ◽

2017 ◽

Vol 3 (3) ◽

pp. 401

Author(s):

Ritesh Kumar ◽

S. Natarajan ◽

Sanjeev Kumar ◽

R. Kalanithi

Keyword(s):

Surgical Technique ◽

Functional Outcome ◽

Proximal Humerus ◽

Constant Score ◽

High Energy ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Proximal Humerus Fractures ◽

Locking Plates ◽

Humerus Fractures

Background: Fracture of proximal humerus incidence has been reported to be 73 cases per 100,000 individuals per year. There are different methods of treatment of proximal humeral fractures. The aim of our study is to analyse the functional outcome of proximal humerus fractures treated with proximal humerus locking plates and to analyse the possible benefits and complications of the procedure.Methods: This is a retrospective study of 34 patients with proximal humeral fractures treated with ORIF using Proximal humeral locking plates from October 2010 to November 2012 at Saifee Hospital, Mumbai. The cases are evaluated as regards to functional outcome using constant score, fracture healing clinically, radiologically and complications if any and reason for them.Results: Our study shows that proximal humerus fractures are now increasingly seen in younger population with good bone stock following high energy trauma. In elderly it was low energy trauma. The average time of radiological fracture union in our study was 10 weeks (8-16 weeks). The mean constant score at final follow up was 66.7 (35-90). A total of 17 patients (51%) had excellent or good results, but in 9 (27%) the outcome was poor. Eight (23%) complications were noted resulting in poor functional outcome. Conclusions: Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. A reproducible standard surgical technique is absolutely necessary for improved patient outcome. Most of the complications in our study were related to the surgical technique. The precise surgical technique, stable fracture fixation and restoration of correct neck shaft angle are absolutely necessary for improved outcome.

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Functional Outcome after Simultaneous Bilateral Four-Part Proximal Humerus Fracture: A Comparison of ORIF and Hemiarthroplasty in an Individual Patient

Case Reports in Orthopedics ◽

10.1155/2012/941829 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Prasad Ellanti ◽

Paul Harrington

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Shoulder Replacement ◽

Oxford Shoulder Score ◽

Objective Outcomes

Simultaneous bilateral four-part proximal humeral fractures are rare. Four-part fractures of the proximal humerus are difficult for the patient and technically demanding for the surgeon. Our surgical tactic is to attempt open reduction and internal fixation where possible. We report the functional outcome in a 56-year-old female who sustained simultaneous bilateral four-part proximal humeral fractures after falling down a flight of stairs. Open reduction and internal fixation using threaded pins and tension band suture was performed on one side, and shoulder replacement hemiarthroplasty was required on the other. Functional assessment was undertaken at two years after surgery, using the Oxford Shoulder Score. Although the objective outcomes assessment revealed little difference, the patient herself expressed a preference for the side treated by internal fixation. We conclude that an attempt to retain the native humeral head and the surgical tactic that favours internal fixation where possible is appropriate in these injuries. Excellent function can be achieved following hemiarthroplasty for trauma in a fit patient.

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Functional outcome of patients treated with proximal humeral internal locking osteosynthesis plate in proximal humeral fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204581 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1182

Author(s):

Tigy Thomas Jacob ◽

Manmatha Nayak

Keyword(s):

Functional Outcome ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Articular Surface ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Humerus Fracture ◽

Excellent Outcome ◽

Osteosynthesis Plate ◽

Philos Plate

Background: Displaced or unstable proximal humeral fractures fare poorly with non-operative treatment. These are better treated with surgical intervention in order to prevent minimal displacement of tuberosity or articular surface from compromising the long term articular function. The objective was to assess the functional outcome of patients treated with PHILOS (the proximal humeral internal locking osteosynthesis) plate in proximal humerus fracture.Methods: 42 patients age group range between 20 and 80 years 61.9% are male and 38.1% are female treated with philos plate. Functional outcome measured by using Constant and Murley score.Results: 50% were Neer two part fractures, 35.7%, three part fractures, 14.3%, four part fractures. After 6 month follow up functional outcome assessed by using constant and Murley score. Excellent outcome in 1 (2.4%) good outcome in 13 (31%), fair outcome in 19 (45.2%) and poor outcome in 9 (21.4%) noted.Conclusions: PHILOS plate fixation of proximal humerus fracture is an effective surgical technique in maintaining stability of fractures and there is significant improvement in functional outcome.

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EVALUATION OF RESULTS OF PROXIMAL HUMERUS FRACTURE TREATED BY PHILOS PLATTING

10.36106/5917334 ◽

2021 ◽

pp. 71-72

Author(s):

Kautilyakumar V. Mahida ◽

Jyotish G. Patel ◽

Ankit Patel

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Constant Score ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Humerus Fracture ◽

Complication Rates ◽

Philos Plate

Purpose: To assess the functional outcome of proximal humerus fracture treated with Proximal Humerus Internal Locking osteosynthesis (PHILOS) plating. Methods: Functional outcomes of 30 patients aged 30 to 75 (mean 57) years who underwent Philos plate xation for proximal humeral fractures were evaluated after taking informed consent about the study. Indications for surgery were 2-part, 3-part or 4-part closed proximal humeral fractures with angulation of more than 45 degrees or displacement of more than 1 cm. All patients satisfying the inclusion criteria were operated and followed up for 6 months .Functional outcomes and shoulder range of movement were assessed based on the Constant scoring system and was done at 6 months postoperatively. Result: Patients were followed up for 6 months. All fractures healed satisfactorily. No wound infections, vascular injuries, avascular necrosis, or loss of xation ensued. One patients with axillary nerve palsy recovered spontaneously within 3 months. Functional outcome was excellent in 11 patients, good in 15, and moderate in 4. The mean Constant score was 83(range 40–100). Conclusion: Proximal humerus fractures treated by Open Reduction and Internal Fixation by Philos plate have good functional results with low complication rates.

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