A STUDY ON FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES TREATED WITH PHILOS PLATING

Background: Proximal humerus fractures are common and debilitating injuries. These fractures have a dual age distribution occurring either in young people following high energy trauma Usually high energy trauma associated with dislocation or in those older than 60 years with low-velocity injuries like simple fall, especially in elderly patients is due to osteoporosis and deforming forces of muscle attached. Wide range of treatment modalities ranging from conservative management to reverse shoulder arthroplasty. The non-operative method gives good results in stable and minimally displaced fractures. Displaced humeral neck fractures used to be managed conservatively in the past, but these were complicated by loss of reduction, malunion, non-union, stiffness and ultimately poor functional outcome. We took up this study to assess the efcacy and functional outcome of P.H.I.L.O.S. plating in proximal humerus. Our objectives are to study the fracture pattern with the Neer's criteria, to reconstruct the proximal humerus fracture anatomically with Philos plate, allow early shoulder mobilization and assessing the functional outcome using Constant Murley score. It is an Materials and methods: observational study of 30 patients (18 females and 12 males) with proximal humerus fractures that attended to the Department of Orthopaedics, Government General Hospital, Rangaraya medical college, Kakinada from December 2018 to December 2020. The mean follow-up Results: period was 12 months. Two patients lost follow-up. Of the remaining 28 patients, all fractures were united clinically and radiologically. At the nal follow-up the mean Constant-Murley score was 69.2 (range 50 -100). The results were excellent in 3, good in 12, fair in 10 patients, poor in 3 patients. During the follow-up 4 cases had varus mal-union, 5 had stiffness of the shoulder, 2 had supercial infection and1 had screw penetration. No cases of hardware failure, locking screw loosening or non-union were noted. T Conclusion: he divergent and convergent orientation of the locking screws of PHILOS plate provides stable biological xation with good radiological union. It minimises the soft tissue dissection and gives both axial and angular stability hence, reducing the risk of fracture displacement.

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Analysis of surgical fixation of displaced proximal humerus fractures using PHILOS plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163509 ◽

2016 ◽

Vol 2 (4) ◽

pp. 245

Author(s):

Lalith Mohan Chodavarapu ◽

Sreekanth Kashayi Chowdojirao ◽

Avinash Gonu ◽

Chandrasekhar Patnala ◽

Vijay Krishna Chilakamarri

Keyword(s):

Proximal Humerus ◽

Dash Score ◽

Proximal Humerus Fractures ◽

Independent Observer ◽

Constant Murley Score ◽

Fracture Dislocations ◽

Philos Plate ◽

Humerus Fractures ◽

The Mean

Background: The treatment of displaced proximal humeral injuries still throws challenges in identifying variables to prognosticate the outcome and optimizing a good clinical result. This study attempts to analyze the functional outcome of surgery of such fractures with proximal humeral interlocking system (PHILOS) plate and evaluate variables which help in predicting the prognosis.Methods: This is a retrospective and prospective study of 30 patients with displaced proximal humerus fractures - 2 part, 3 part, 4 part and fracture dislocations according to Neer classification, surgically treated using PHILOS plate during 2011 and 2014. Evaluation of patients was done on follow-up by an independent observer for union by radiographs and functional assessment by Constant-Murley score and DASH (disabilities of the arm, shoulder and hand) score.Results: The mean age of the patients was 40.4 years (range 18-65). 83.3% of the patients were male. The mean follow-up was 18.9 months (4-36 months). The mean Constant-Murley score and the DASH score were 76 and 16 respectively at the last follow-up. Our analysis showed that the patient’s age, delay in surgery, and Neer’s classification influenced the prognosis of the fracture. Medial metaphyseal extension in the fracture or an intact medial neck showed a better outcome. Complications were seen in 5 patients. Avascular necrosis was seen in 3 patients.Conclusions: Osteosynthesis of displaced proximal humeral fractures with PHILOS plate provides a good outcome, with low complication rate. Patient’s age and the type of fracture based on Neer’s classification prognosticate the outcome.

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Outcome of locking plate fixation for proximal humerus fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20160712 ◽

2016 ◽

Vol 2 (1) ◽

pp. 25

Author(s):

Neil Rohra ◽

Jimmy Chokshi ◽

Rishi Sanghavi

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Proximal Humerus ◽

Evaluation Criteria ◽

Proximal Humerus Fractures ◽

Age Group ◽

Philos Plate ◽

Humerus Fractures ◽

The Mean

Background: The objective of the study was to evaluate functional outcome of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.Methods: We reviewed 30 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2010 to 2015. There were 23 men and7 women with a mean age of 36 years (range 20-64).There were 22 patients in the age group of <60 years and 8 patients in the age group of >60 years. According to Neer classification system, 12, 11 and 4 patients had2-part, 3-part, and 4-part fractures, respectively and 2 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma center. Functional evaluation of the shoulder at final follow-up was done using Neer’s Evaluation Criteria.Results: The mean follow-up period was 20 months (range 14-40 months). All fractures united clinically and radio logically. The mean time for radiological union was 13.2 weeks (range 9-26 weeks).At the final follow-up the mean Neer’s Evaluation Criteria was 90 (range 76-100). The results were excellent in 17patients, Satisfactory in 8 patients, Unsatisfactory in 4 patients and Failure in 1 patient. During the follow-up, 3 cases of varus malunion, 1 case of failure of fixation were noted. No cases of AVN, hardware failure, locking screw loosening, infection or nonunion were noted.Conclusions: PHILOS provides stable fixation in proximal humerus fractures. In order to prevent the complications like avascular necrosis, knowledge of anatomy and vascular supply of head of humerus and good surgical dissection to preserve vascularity of humeral head is important.

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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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Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely – A Retrospective Study

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211050155 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110501

Author(s):

Huihui Cheng ◽

Jiali Yu ◽

Zhirui Dong ◽

Huanyi Lin ◽

Qilong Liu ◽

...

Keyword(s):

Elderly Patients ◽

Proximal Humerus ◽

Secondary Outcome ◽

Proximal Humerus Fractures ◽

Severe Osteoporosis ◽

Non Union ◽

Loss Of Reduction ◽

Philos Plate ◽

Humerus Fractures

Introduction To date, there is little research assessing the efficacy of a proximal humeral internal locking system (PHILOS) plate plus an allogeneic fibula inserted obliquely in the treatment of 2-part proximal humerus fractures (PHFs) with calcar comminution in patients >60 years old with severe osteoporosis. The aim of this study was to retrospectively evaluate the outcomes of elderly patients with osteoporotic 2-part PHFs combined with medial column (calcar) instability or disruption who experienced a PHILOS plate plus an allogeneic fibula inserted obliquely. Materials and Methods One hundred and twelve consecutive elderly patients with severe osteoporotic 2-part PHFs combined with calcar instability or disruption who were treated with a PHILOS plate plus an allogeneic fibula inserted obliquely were retrospectively identified from 3 tertiary medical centres during 2014–2019. The primary outcomes were the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores; secondary outcome was the rate of key orthopaedic complications. Results Median follow-up was 24 (15.3–27.6) months. Significant improvements in the median Constant scores were observed (39 [26–58 points] prior to surgery vs 81 [67–95 points] at final follow-up). The median ASES scores improved from 43 (26–64 points) prior to surgery to 83 (65–96 points) at final follow-up. The percentage of key orthopaedic complications was 25.6% (22/86). Four (4.7%) cases had loss of reduction, 4 (4.7%) experienced aseptic loosening, 1 (.8%) had non-union, 4 (4.7%) suffered a periprosthetic fracture, 3 (3.5%) experienced a revision surgery, 1 (.8%) had a dislocation and 5 (5.8%) suffered an unbearable shoulder pain. Conclusion For elderly patients with osteoporotic 2-part PHFs combined with calcar instability or disruption, PHILOS plate combined with an allogeneic fibula inserted obliquely might have recognisable advantages in decreasing the loss of fixation and preventing medial calcar collapse.

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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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Potential outcome of locking compression plate in proximal humerus fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184238 ◽

2018 ◽

Vol 4 (6) ◽

pp. 835

Author(s):

J. P. V. Jebaraj ◽

B. Sundararaja

Keyword(s):

Functional Outcome ◽

Proximal Humerus ◽

Bone Fractures ◽

Plate Fixation ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Non Union ◽

Compression Plate ◽

Humerus Fractures

Background: Fractures of proximal humerus bone needs immediate attention as the delayed treatment might result in non-union, malunion, and avascular necrosis which are responsible for the pain and dysfunction. The aim of the present study is to evaluate the functional outcome of displaced proximal humerus bone fractures that are surgically managed by locking compression plate and to assess the potential complication.Methods: The present study is the combination of both prospective and retrospective in which 30 patients with either Neer’s three part or Neer’s four-part proximal humerus fractures which were fixed with locking plate by a single surgeon. Functional outcome was measured by Constant Murley scoring (CMS) system.Results: The final follow-up of the study showed that 21 patients (70%) had the result that ranged from good to excellent score whereas, 6 patients (20%) had moderate score and 3 patients had poor score in functional outcome according to CMS system. During follow-up, 3 complications (10%) were encountered.Conclusions: The study concluded that proximal humerus locked compression plate is a valuable surgical method for the fixation of comminuted fractures of the proximal humerus as it is associated with excellent functional outcome. It also provides a stable fixation to permit early mobilization. Regaining medial cortical contact and establishing anatomical reductions decreases the complications that are associated with plate fixation.

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Factors Influencing Functional Outcome of Philos Plate Fixation for Proximal Humerus Fractures

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v16i1.1147 ◽

2017 ◽

Vol 16 (1) ◽

Author(s):

Hazwan Ab. Wahid ◽

Khairul Nizam Siron ◽

Ahmad Zakiran

Keyword(s):

Functional Outcome ◽

Proximal Humerus ◽

Constant Score ◽

Plate Fixation ◽

Impingement Syndrome ◽

Proximal Humerus Fractures ◽

X Rays ◽

Philos Plate ◽

Humerus Fractures

Introduction: Displaced and unstable proximal humerus fractures are difficult to treat and they have high morbidity. The main goal is to achieve painless shoulder with full recovery of the shoulder joint motion. Impingement syndrome is one of the commonest postoperative complication. This study aim is to appreciate the functional outcomes of Philos-plate fixation for proximal humerus fractures and to establish association with high plate positioning with impingement syndrome of the shoulder after Philos-plate fixation. Materials and method: This is a retrospective study, reviewing 26 patients who had proximal humeral fractures and underwent open reduction and Philos-plate fixation between December 2010 and January 2015 in Hospital Tengku Ampuan Afzan, Kuantan. Preoperative X-rays or CT scans were inspected, follow-up visits and X-ray images were obtained at every follow-up to evaluate the plate position and bone union. Assessments of impingement syndrome and other complications were done and also functional outcome measured with Constant shoulder scoring system during final follow-up. Results: Almost 70% of patients achieved good (Constant score: 71-85) to excellence (Constant score: 86-100) outcome, with 77.54 mean Constant score. All cases achieved union. None of the cases developed complications like malunion, infection, AVN, and loosening of implant while 2 cases complicated with shoulder impingement post operatively. Among all the factors, age more than 60 years, and high plate position found to be a significant factor in the outcome of the surgery where both factors yielded significantly less mean Constant scores. Neer 3 parts fractures have higher mean of Constant score compare to Neer 4 parts fractures and high plate position is significantly associated with impingement syndrome postoperatively. Conclusion: This study showed that age, fracture type and plate position were key factors affecting shoulder function after Philos locking plate fixation surgery. We recommend that plate should be position at most 10mm from the greater tubercle to prevent impingement syndrome postoperatively and for better functional outcome.

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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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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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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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