Use of proximal humerus internal locking system plate in proximal humerus fractures and its relation with the functional outcome

Background: Proximal humerus fractures are the fractures occurs at or proximal to the surgical neck of the humerus, which accounts for 7% of all fractures and 80% of all humeral fractures. Now a days most of these fractures are managed with internal fixation because of better availability of anatomical plates. The aim was to assess the functional outcome and complications of proximal humerus fractures treated with proximal humerus internal locking system (PHILOS).Methods: This is a prospective study of 30 patients with two, three, and four parts proximal humerus fractures treated with proximal humerus internal locking sysyem from 2016 to 2018 with 25 to 80 years of age in a tertiary care hospital. Functional outcome is assessed by using constant murley shoulder scoring system.Results: Functional outcome as per constant score, 10 patients (33%) got excellent outcome, 06 patients (20%) got very good outcome, 07 patients got (23%) good outcome, 05 patients got (17%) fair outcome and 02 patients got (07%) poor outcome. Complications observed were superficial infections, implant failure and axillary nerve neuropraxia.Conclusions: Open reduction and internal fixation by using PHILOS is the ideal method in treating displaced proximal humerus fractures mainly in two and three part proximal humerus fractures which provides stable fixation and less complications.

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FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION WITH A LOCKING COMPRESSION PLATE: A CROSS SECTIONAL STUDY

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i4.1407 ◽

2021 ◽

Vol 10 (4) ◽

pp. 3266-3269

Author(s):

Abhishek Patil

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Proximal Humerus ◽

Constant Score ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Humerus Fractures ◽

The Mean

Proximal humerus fractures account for about 4% to 5% of all fractures. Following distal forearm fracture, proximal humeral fracture is the second most common upper extremity fracture. Kirschner (K)-Wires, external fixation, tension band wiring, and rush pins, intramedullary nails, ORIF with plates, and shoulder hemiarthroplasty have all been offered as therapeutic options. The purpose of this study was to assess the functional outcome and complication rates following internal fixation of proximal humerus fractures using a locking compression plate. Patients over the age of 18 with closed proximal humerus fractures or open proximal humerus fractures (Gustilo and Anderson type I, Type II) received open reduction and internal fixation with locking compression plate in the current study. The participants in this study were 60 people who had a proximal humerus fracture and were treated with open reduction and a proximal humerus locking compression plate. Patients ranged in age from 20 to 85 years old, with a mean age of 51.14 +/- 17.30 years. The age group 36–55 years (37 percent) was the most prevalent, followed by 56–75 years (30 %). The majority of patients (76.7 %) were men who had been in automobile accidents on the right side (83 %) (63 %). According to the Neer classification, the most prevalent type of fracture was a three-part fracture (53 %). The maximum union time observed in this study was 16 weeks, with a minimum of 10 weeks. The average time to union is 12.52 +/- 1.14 weeks. The mean flexion at the end of six months was 121.660 +/- 19.84. The mean internal rotation was 57.330 +/- 8.48, the mean external rotation was 530 +/- 11.98, and the mean abduction was 1180 +/- 19.36. 75.28 +/- 9.66 [Mean +/- SD] is the Mean Constant score. Pain 14.10, ADL 18.26, range of motion 22.46, and power 20 were the mean scores observed on Constant Score for its various aspects. According to the Constant score, the functional outcome of the 60 patients was as follows: 8 patients had excellent outcomes (13%), 34 patients had good outcomes (56.7%), 16 patients had moderate outcomes (26.7%), and two patients had poor outcomes (26.7%) and (3 %). Internal fixation of proximal humerus fractures with a locking compression plate results in anatomical reduction and secure fixation, resulting in a favorable functional outcome.

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Study of functional outcome of surgical management of proximal humerus fracture by various modalities: a two-year study at a tertiary care hospital

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200003 ◽

2020 ◽

Vol 6 (2) ◽

pp. 242

Author(s):

Addanki Vijayanand ◽

Narreddy Jayasomeswar

Keyword(s):

Functional Outcome ◽

Surgical Management ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Tertiary Care ◽

Humerus Fracture ◽

Significant Heterogeneity ◽

Care Hospital ◽

Proximal Humerus Fractures ◽

Humerus Fractures

Background: Proximal humerus fractures account for nearly 6-10% and are on a rise. The management of this is controversial and is challenging task. There is a significant heterogeneity among the studies in describing the best surgical procedure in proximal humerus fracture. The objective of the study is to assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures.Methods: A two-year prospective study was conducted after getting ethical approval at Narayana Medical College on cases admitted with proximal humerus fractures as per the inclusion criteria based on Neer’s classification. Radiological evaluation was done, and surgery was performed. Postoperative follow-up was done at 1st, 4th, 8th and 14th week and outcome were evaluated for each case based on Neer’s shoulder score.Results: 30 cases were included with a mean age of 48.2 years. Road traffic injury was common cause of fracture. Of the total 30 cases, 23 cases had excellent results, 4 cases were satisfactory, 2 cases were unsatisfactory, and one case had a failure. The mean scores observed on Neer’s score was pain (33.5 units), Function (23.5 units), range of motion (16.55 units) and anatomy (6.9 units).Conclusions: Clinical evaluation, obtaining proper radiological views, age of the patient and activity holds the key for realistic approach and surgical management of complex humerus fractures. Proper patient selection and thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery and good functional outcome.

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Evaluation of functional outcome of proximal humerus fractures managed by open reduction and internal fixation with philos plate

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i2g.2072 ◽

2020 ◽

Vol 6 (2) ◽

pp. 403-410

Author(s):

Dr. Rishi Solanki ◽

Dr. Sharvin K Sheth ◽

Dr. RA Solanki ◽

Dr. Rahil Pankajkumar Shah ◽

Dr. Vats Ganesh Joshi ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Proximal Humerus ◽

Proximal Humerus Fractures ◽

Philos Plate ◽

Humerus Fractures

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PROXIMAL HUMERUS FRACTURES;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.12.571 ◽

2017 ◽

Vol 24 (12) ◽

pp. 1788-1793

Author(s):

Faisal Abdul Jabbar ◽

Rehana Ali Shah

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Avascular Necrosis ◽

Open Reduction ◽

Proximal Humerus ◽

Case Series ◽

Proximal Humerus Fractures ◽

Humerus Fractures ◽

The Mean

Objectives: The aim of our study is to study the radiological and functionaloutcome of proximal humerus fractures treated via open reduction and internal fixation usingthe proximal humerus internal locking system or PHILOS. Study Design: Case series study.Period 05 years duration from January 2011 to December 2015. Setting: Large tertiary carecentre in Karachi, Pakistan. Materials and methods: The study population consisted of n=50patients all of whom underwent open reduction and internal fixation utilizing the proximalhumeral internal locking system or PHILOS for fractures of the proximal humerus. The inclusioncriterion was all the patients with closed fractures of the proximal humerus and were belongingto 2,3 and 4 part of the Neer system of classification. Physiotherapy was started as soon aspossible for the patients. Serial radiographic imaging in two views was done at 6, 12, 24 and52 weeks postoperatively. For the functional outcome of the procedure Constant and Murleyscoring system was used. Data was analyzed using IBM SPSS version 21. Results: The studypopulation consisted of n= 50 patients of which n= 35 were males and n= 15 were femaleshaving a mean age of 38.50 years. The mean duration of follow up was 24 months. All thepatients in the study had union of fracture both radiographically and clinically, the mean timeduration for the radiographically evident union of the humerus bone was 12 weeks with a rangeof 8 to 20 weeks, the mean Constant Murley score for the functional outcome of the shoulderjoint was 79 at the final follow up with a range of 50 to 100. Complications were found in n= 9patients and varus malunion was the most common complication. In our case series we did notobserve complications such as avascular necrosis, non union or implant failure. Conclusion:According to the results of our study the proximal humerus internal locking system or PHILOSis a good method for open reduction and internal fixation of the proximal humerus fractures andprovides a stable fixation, and has lower incidence of complications such as avascular necrosis.

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Study of surgical management of fracture of proximal humerus by PHILOS plate and screws

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201722 ◽

2020 ◽

Vol 6 (3) ◽

pp. 462

Author(s):

Channappa T. Seetharam ◽

Manju Jayaram ◽

Shivakumar H. Bachhappa ◽

Yatish Ramalingaiah ◽

Syed Abdul Hadi

Keyword(s):

Functional Outcome ◽

Proximal Humerus ◽

Plate Fixation ◽

Angular Stability ◽

Rigid Fixation ◽

Functional Evaluation ◽

Proximal Humerus Fractures ◽

Excellent Outcome ◽

Philos Plate ◽

Humerus Fractures

Background: Proximal humerus fracture accounts for about 5% of all fractures in recent advances proximal humerus fractures are often managed operatively with PHILOS plate which provides greater angular stability and study was aimed at to assess functional outcome of PHILOS plate fixation in proximal humerus fractures.Methods: Prospective study of 31 cases of proximal humerus fractures admitted and operated in Kempegowda Institute of Medical Sciences Hospital November 2017 to May 2019 of which 4 patients died due to medical comorbidities so 27 patients were studied. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Constant and Murley (CM) scoring and disabilities of the arm, shoulder and hand (DASH) scoring.Results: CM scoring and DASH scoring was applied to analyze the functional outcome among the cases. Most of the patients had excellent outcome (52%) followed by good (26%), fair (8%) and poor (15%) outcome according to CM scoring and according to DASH scoring 20.21 was mean score and mean CM score was 77.62. Complications observed were impingement in 1 patient, avascular necrosis in 2 patient and non union in 1 case.Conclusions: We conclude that the use of PHILOS plate for the fixation of proximal humerus fractures is a good device as it provides rigid fixation and early mobilisation and prevented complications. Precontoured locking plates work on the principle of angular stability, divergent screws, less disruption of vascularity and less chances of plate failure.

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Treatment of proximal humerus fracture using proximal humerus locking plating

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172712 ◽

2017 ◽

Vol 3 (4) ◽

pp. 670

Author(s):

Niranjan D. Tadvi ◽

Rajesh N. Deveshawar ◽

Yogesh C. Patel

Keyword(s):

Functional Outcome ◽

Proximal Humerus ◽

Proximal Humerus Fractures ◽

Locking Plates ◽

Low Velocity ◽

Female Ratio ◽

Excellent Outcome ◽

Constant Murley Score ◽

Humerus Fractures

Background: Proximal humerus fractures are the most common upper extremity fractures in older patients. The aim of the present study was to evaluate the functional outcome and complications of proximal humeral locking plate used for healing proximal humerus fractures.Methods: This prospective study was conducted at the department of Orthopaedics, Sir T. Hospital, Bhavnagar, from June 2008 to March 2010, with 20 patients who suffered with complex proximal humerus fractures and underwent surgical treatment with proximal humerus locking plates. Functional outcome was assessed at the final follow up by using Constant Murley score.Results: The mean age of the patients was 52 years. Male: female ratio was 1.5: 2. The most common mode if injury is low velocity trauma i.e. fall while walking or fall in bathroom seen in 13 patients. Average time for clinical union was 60 days, while average time for radiological union is 90 days taken in the study. Postoperative complications were seen in 2 patients. Delayed complications were seen in 10 cases. No patients had shown implant related complications. At the final follow up according to Constant Murley score, 36% patients had shown excellent results, 53% patients had shown good results and poor results were seen in 11% of cases.Conclusion: Our results show that good to excellent outcome can be achieved in treating proximal humerus fractures using locking plates in elderly patients. Early mobilization of the shoulder can be achieved without compromising fracture union.

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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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Study of functional outcome of proximal humerus fractures managed by open reduction and internal fixation with locking compression plate at a tertiary hospital

MedPulse International Journal of Orthopedics ◽

10.26611/10201721 ◽

2020 ◽

Vol 17 (2) ◽

pp. 15-19

Author(s):

Snehal Hedgire ◽

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Proximal Humerus ◽

Tertiary Hospital ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Humerus Fractures

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A study of proximal humerus fractures treated by PHILOS plating in a tertiary care hospital

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193133 ◽

2019 ◽

Vol 5 (5) ◽

pp. 838

Author(s):

S. Srikanth ◽

A. Varun Kumar Reddy ◽

Gudapati Omkarnath

Keyword(s):

Functional Outcomes ◽

Proximal Humerus ◽

Tertiary Care ◽

Care Hospital ◽

Proximal Humerus Fractures ◽

Locking Plates ◽

Poor Bone Quality ◽

Comminuted Fractures ◽

Philos Plate ◽

Humerus Fractures

Background: Proximal humeral fractures are commonly presented in the orthopedic practice. The usual method of treatment was conservative in the past. However, the results and functional outcomes were not good. With the development of PHILOS locking plates, the functional outcomes are known to be improved. We in the present study tried to evaluate the functional outcomes of proximal humerus fractures treated with PHILOS plates.Methods: This prospective study was conducted in all Adult patients with closed two-part and three-part fractures of the proximal humerus, those who have reported within a week of the injury were included in the study. A total of n=30 patients were included in the study based on the inclusion and exclusion criteria. A standard surgical approach with PHILOS plate was used and patients were followed up for 19 to 24 months.Results: n=30 patients out of which n=16 (53.33%) were males and n=14 (46.67%) were females. The most common age group involved in the fractures was 31-35 years n=9 (30%) of the patients. Most of the patients n=21 (70%) were having Neer's two-part fractures and three-part fractures were found in n=6 (20%) and four part in n=3 (10%). The overall results in the study were 66.67% of patients had excellent results and 16.67% had good results and 10% had poor results.Conclusions: PHILOS locking plates is a better treatment option for fractures of proximal humerus especially in cases of poor bone quality and comminuted fractures.

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Functional outcome following open reduction and internal fixation of proximal humerus fractures with locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205465 ◽

2020 ◽

Vol 7 (1) ◽

pp. 29

Author(s):

Mohamed Nishad M. ◽

Mohamed Shakeeb K. U. ◽

Gijo A. J.

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Treatment Modality ◽

Open Reduction ◽

Proximal Humerus ◽

Proximal Humerus Fractures ◽

Road Accidents ◽

Locking Compression Plates ◽

Life Style Changes ◽

Humerus Fractures

Background: Proximal humerus fractures (PHFs) are common upper extremity fractures representing break in humerus bone. Incidences of PHFs increased in last few years due to life style changes and increased road accidents. Appropriate management strategy for PHFs is still uncertain. The aim of current study is to assess the functional outcome following open reduction and internal fixation of proximal humerus fractures using locking compression plates.Methods: Current study is a descriptive investigation conducted on 31 PHFs patients admitted to baby memorial hospital, calicut, between January 2013 to June 2014. Surgical management of PHFs was done by open reduction and internal fixation using locking compression plates and functional outcomes and complications of the employed treatment modality were investigated.Results: PHFs were observed to be common in 41-60 years age group, with 65% males being affected. Road accidents and domestic falls were observed to be the most common causes of PHFs in younger and elderly populations respectively. Three parts PHFs were observed to be more prevalent, followed by two and four parts fractures. Results of current study revealed that majority of PHFs united by 8-10 weeks duration with 22.58% cases with excellent and 41.93%, 16.12% and 19.35% cases with good, moderate and poor constant and Murley score respectively. Two patients reported post-operative complication of shoulder stiffness, while one patient each reported plate impingement, varus maluion, infection and varus malunion with intraarticular screw cut-out. Conclusions: Locking compression plates (PHILOS/PHLP) is an efficient treatment modality for proximal humerus fractures allowing early mobilization and good functional outcome.

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