Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 3 Issue 11

Analysis of Functional Outcome in Proximal Humerus Plating (PHILOS) in Displaced Proximal Humerus Fracture

Dhruv Pandya1 and Krunal Soni2*

1Senior Resident, Department of Orthopaedics, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.
2Assistant Professor, Department of Orthopaedics, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India

*Corresponding Author: Krunal Soni, Assistant Professor, Department of Orthopaedics, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.

Received: August 03, 2020; Published: October 20, 2020

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Abstract

Background: Fractures of proximal humerus are common and debilitating injuries increasing seen in the elderly population [1]. Neer classification remains most widely used today [7]. Optimal treatment of three- or four-part fractures of proximal part of the humerus in elderly patients is controversial. However, recent advances in fracture fixation technology has led to development of fixed angle locked plates (PHILOS) that maintain angular stability under load [18].

Methods: This retrospective study included 41 patients aged > 18 years with fractures of the proximal humerus, including two-, three-, and four-part fractures, treated by open reduction and internal fixation with PHILOS plating. Patients were functionally evaluated based on subjective (35 points) and objective (65 points) parameters as per the Neer scoring system.

Results: All these operated patients were followed up for 12 - 18 months. Functional outcome based on the Neer scoring system showed 32 patients had good outcome scores (78%) which include excellent and satisfactory result, whereas 9 patients had poor outcome scores (22%) which include unsatisfactory and failure results, out of which 4 patients had avascular necrosis and were treated with Shoulder Hemiarthroplasty, 4 patients presented with varus malunion and treated with Osteotomy and revision plating and 1 patient underwent implant removal and physiotherapy.

Conclusion: Proximal humerus locking plate is a preferred option for management of in all types of Neer’s fracture types of proximal humerus and fracture dislocation of proximal humerus. The present study concludes that it is a promising implant working by a dual mechanism i.e. a buttressing effect laterally and inferomedial support by locking screws, which prevent varus displacement of proximal fragment and thus it provides a good functional outcome in proximal humerus fractures.

  However, complications are not uncommon with PHILOS plates. And therefore, a thorough understanding of fracture morphology using pre-operative planning with 3D CT scan, sound surgical techniques and proper plate positioning is necessary to achieve good functional outcomes.

Keywords: Proximal Humerus Fracture; Neer Classification; Locking Plates

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Citation

Citation: Dhruv Pandya and Krunal Soni. “Analysis of Functional Outcome in Proximal Humerus Plating (PHILOS) in Displaced Proximal Humerus Fracture".Acta Scientific Orthopaedics 3.11 (2020): 37-49.




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