Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system

Abstract

Secure fixation of displaced proximal fractures of the humerus is a challenging problem. A total of 32 patients with acutely displaced three- or four-part proximal fractures of the humerus were treated by open reduction and internal fixation using the proximal humeral internal locking system (PHILOS) plate. There were 23 women and nine men with a mean age of 59.9 years (18 to 87). Data were collected prospectively and the outcomes were assessed using the Constant score. The mean follow-up was for 11 months (3 to 24). In 31 patients (97%) the fracture united clinically and radiologically at a mean of 10 weeks (8 to 24). The mean Constant score at final review was 66.5 (30 to 92). There was no significant difference in outcome when comparing patients aged more than 60 years (18 patients) with those aged less than 60 years (14 patients) (t-test, p = 0.8443). There was one case each of nonunion, malunion and a broken screw in the elderly population. This plate provides an alternative method of fixation for fractures of the proximal humerus. It provides a stable fixation in young patients with good-quality bone sufficient to permit early mobilisation. Failure of the screws to maintain fixation in the elderly remains a problem.

Proximal Humerus Fractures; Radiological and Functional Outcome as Treated With the Philos Plating System, at a Tertiary Care Centre in Karachi, Pakistan.

“…15,16,17 In our study we utilized the deltopectoral approach in the patients of the proximal humerus fractures, the important points that must be taken care of are the placement of the plate of proper length, using the fluoroscopic imaging when placing the screws in the correct position and avoiding the varus displacement by ensuring support to the medial side of the cortex. 18,19,20 The overall complication rate in our study was found to be 18% and 10% of the patients had varus malunion, while the remainder of the complications were impingement, infection, failure of fixation and intra articular screw, revision surgeries were performed for the patients with deep infection and failure of fixation. In the study by Egol et al they had an infection rate of 1.61% in their case series and similar rate of observed in a study by Moonot et al and Gardner et al, in which the patients of infection were treated with antibiotics only.…”

A Report on Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

“…Older age and requiring revision surgery were mentioned as the most predictive factors yielding undesirable outcome. Two other reports from early experiences by Moonot & Koukakis [9,10] have also provided valuable information with almost similar outcomes. In the study by Moonot, it was mentioned that good bone density permits early post-operative mobilization of upper extremity.…”

“…The Proximal Humeral Internal Locking System (Philos®) plate has specifically been designed to provide stability in proximal humeral fractures. It can be applied with a minimally invasive method and has screws which are placed in converging and diverging directions [9]. Several holes in the proximal part of the plate function as suturing anchors to the rotator cuff.…”

Functional Outcome of Locking Compression Plate in Neer's two-part, three-part, four-part Proximal Humerus Fractures

“…Our study has similar results compared with other studies of surgical management of the proximal humerus. 25,[30][31][32][33][34][35][36] Proximal humerus fractures occur more commonly in the middle age group. Numerous age-related studies point toward this, and our study is consistent with this finding.…”