Assessment of Surgical Outcome in Three- and Four-Part Proximal Humerus Fracture Treated With Proximal Humerus Internal Locking System (PHILOS) Plate Versus Neer’s Prosthesis in Elderly Patients

Abstract

Background: With an incidence of 50% of humerus fractures, proximal humerus fractures (PHFs) can significantly impact one's quality of life. Moreover, management of highly comminuted or displaced PHFs poses a significant challenge amongst elderly population due to poor bone quality. Prosthetic replacement of humeral head or its stabilization using external plates is a commonly employed intervention for treating three-and four-part PHFs. Thus, these two methods were compared in this study to identify a preferable intervention.Methods: Patients were randomly divided into two groups to receive proximal humerus internal locking system (PHILOS®, Synthes, Switzerland) plating and Neer's hemiarthroplasty. The deltopectoral approach was deployed as the surgical method. Their surgical outcome was assessed from functional range of motion (ROM) and Constant-Murley scores at regular intervals of three, six, twelve, and twenty-four weeks.Results: Twenty patients were divided into two groups who received PHILOS ® plating and Neer's hemiarthroplasty, averaged 67.2 years and 72.8 years. The ROM pertaining to flexion, extension, abduction, internal rotation, and external rotation for individuals with PHILOS ® plating was 20%, 12.5%, 14.7%, 11.5%, and 18.5% higher than those who received Neer's hemiarthroplasty. Moreover, the Murley score was also 8.7 units higher for individuals with PHILOS ® plating.Conclusions: Prognosis following PHILOS® plate osteosynthesis had a better overall outcome than hemiarthroplasty with Neer's prosthesis. Although hemiarthroplasty yielded a consistent functional outcome, PHILOS® plate osteosynthesis tends to restore a greater ROM. Thus, PHILOS® plating is recommended as the suitable method to manage three-and four-part PHF for people above fifty-five years of age.

Outcome of Neer Type 3 & 4 Fractures of Humeral Head Treated with Proximal Humerus Internal Locking System (PHILOS) Plate Osteosynthesis

“…In the present research, the functional outcome after 6 months follow up, 10 19 . Other researchers have also shown that PHILOS plate is useful in majority of fractures with help of correct surgical technique.…”

“…In our study, the injury was implicated by simple fall and fall from height in 36.7% patients, 6.7% had physical assault and 56.7% had fracture because of road traffic accidents. In a study presented from UK by the Gaheer et al, mechanism of injury was fall in 78.6% patients while 12 (21.4%) patients had road-traffic accidents 12 .…”

“…10,11 The PHILOS plate is intended to result in improvement in fixation of screw and reduction in soft tissue dissection to minimum. This aim is achieved by multi-directional locking screws for the head, pre-contouring of plate as well as locking screws in 3 & 4 part PHF 12 . Some researchers have observed that PHILOS plate resulted in good outcomes in treating patients with displaced 3 and 4-part PHF, and quite stable fixation is achieved which allows early mobilization [13][14][15] .…”

Comparison of Functional Outcome and Union of Proximal Humerus Fractures Fixed with Philos Plate Versus T Plate

“…Previous study showed comparable results. [20] Plate-and-screw fixation is commonly used to treat proximal humeral fractures, however it has been related to complications such as screw pullout in osteoporotic bone, subacromial friction, and avascular necrosis of a humeral head from extensive periosteal stripping. [21] There is a significant rate of fixation failure after T-buttress plates are used for proximal humeral fractures, according to research by Kristiansen and Christensen.…”