A prospective study of 30 cases of PHILOS plating for displaced proximal humeral fractures

Abstract

Introduction: Fractures of proximal humerus is still unsolved fractures in many ways. The Proximal humeral internal locking system (PHILOS) plate fixation provides greater angular stability, works as a locked internal fixator and provides better anchorage of screws in osteoporotic bone, early joint mobilisation and good functional outcome. Considering these advantages and the scarcity of data on the efficacy and the functional outcome following internal fixation with PHILOS plate for displaced proximal humerus fractures, the present study was planned. Materials and Methods: This study was conducted from October 2014 to October 2016. 30 cases who sustained proximal humerus fractures were enrolled in the study. Through delto-pectoral approach, the fracture site was reduced and fixed with PHILOS plate. Follow up was done at 6 wks, 12 wks and 6 months. Patients were evaluated for 1.Range of motion of the Shoulder. 2. Complications. 3. Clinical union. 4. Radiological union. The final assessment was done using DASH score for outcome. Results: Excellent outcome was noted in 20%, good in 47%, fair in 26% and poor in 7%. The outcome was independent to side of fracture (p=0.935), mode of injury (p=0.914) and type of fracture (0.562) as no statistically significant association was noted. 90% patients had clinical and radiological union at three months. The range of motion at first, second and third follow ups showed gradual increase in mean flexion, abduction, external rotation and internal rotation. Conclusion: PHILOS plate provides a high degree of angular and axial stability eliminating screw loosening and backout. The divergent and convergent orientation of the screws engaging in the humeral head prevent pull out and failure of fixation. The PHILOS plate is an ideal construct and a stable implant to use for fractures of the proximal humerus in Neer’s 2-part, 3-part, and 4-part and osteoporotic fractures.