functional outcome and complications following PHILOS plate fixation proximal humeral fractures

Abstract

Objectives: Proximal humeral fractures account for approximately 5% of all fractures. New plating techniques have been developed to improve stability. The purpose of this study was to evaluate functional outcome following plate fixation with the Proximal Humeral Internal Locking System (PHILOS) and to analyze potential implant-related complications. Methods: The PHILOS plate was used for internal fixation of displaced proximal humeral fractures in 28 patients (20 females, 8 males; mean age 60.7±12.9 years). Fractures were caused by low-energy trauma (fall from standing height) in 21 patients, and by an accident while skiing or cycling in seven patients. Involvement was on the right in 16 cases and on the left in 12 cases. According to the Neer classification, 8, 12, and 8 patients had displaced 2-, 3-, or 4-part fractures, respectively. All patients received a similar physical therapy program following internal fixation with the PHILOS plate. The patients were assessed clinically and radiographically after a mean follow-up of 25.2±11.8 months. Functional outcome was assessed using the Constant-Murley score adjusted for age and gender. Range of motion and shoulder abduction strength were measured. The patients were also evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a visual analog scale (VAS). Complications during the follow-up period were recorded. Results: Twenty fractures (71.4%) healed in good anatomical position. At the end of the followup period, the mean Constant-Murley score was 57.9±21.7, and the mean age-and gender-adjusted Constant-Murley score was 67.5±23.6. The results were excellent or good in 16 patients (57.1%), moderate in one patient (3.6%), and poor in 11 patients (39.3%). The mean DASH and VAS scores were 28.3±24.3 and 75.4±21.2, respectively. Eleven complications (39.3%) were seen during the follow-up period. Reoperation was required in eight patients (72.3%). Complications included avascular necrosis of the humeral head in two patients (7.2%), subacromial impingement in six patients (21.4%), loosening of a locking head screw in one patient (3.6%), and transiently decreased radial nerve sensation in two patients (7.2%). Subacromial impingement was mainly caused by the superior plate position. Conclusion: Our results demonstrate that the PHILOS plate provides sufficient fracture stabilization in the treatment of proximal humeral fractures of elderly patients.Proximal humeral fractures account for approximately 5% of all fractures. [1] Within the last three decades, the age-adjusted incidence of proximal humeral frac-tures increased by 15% per year. Increased incidence of proximal humeral fractures is associated with more complications. [2]

Proximal humeral fractures

“…There have been several recent studies which have demonstrated satisfactory outcomes following ORIF of proximal humeral fractures [25,[27][28][29][30][31][32]. Brunner et al [27] treated 158 fractures and at 1 year follow up noted a Constant score of 72.…”

Comparison of lateral deltoid splitting and deltopectoral approaches in the treatment of proximal humerus fractures

“…Proksimal humerus kırıkları-nın tedavisinde kullanılan diğer cerrahi yaklaşım lateral deltoid split girişimdir. [1,2] Deltoid split yaklaşımla humerus başı, tüberculum majus, proksimal humeral şaftın lateral kısmı ve döndürücü manşet direkt görüntülenebilir. Bu yaklaşımın en önemli tehlikesi, aksiller sinirin seyri ve bu sinire ait varyasyonlardan kaynaklanmaktadır.…”

Study of operative management of proximal humerus fracture treated with locking plates

“…1 Their incidence is particularly higher in patients over 65 years age in whom they represent the most common fracture type. 2,3 Most proximal humerus fractures are stable, minimally displaced and can be managed conservatively.…”

“…The insertion of multiple polyaxial locking screws through the specific targeting device into humeral head fragment provides a fixed angle support in multiple planes, which should in theory, maintain the reduction achieved , while allowing for early mobilisation. 1 However inspite of all potential benefits significant level of construct failure and revision surgery with the use of proximal humerus locking plates have been reported particularly in patients over 65 years of age. reduction and internal fixation with a Philos plate (Synthes).…”