A prospective study to assess the surgical outcome in three- and four-part proximal humerus fracture with PHILOS plate

Abstract

Background: Optimal surgical management of three- and four-part proximal humeral fractures in osteoporotic patients is controversial, with many advocating prosthetic replacement of the humeral head. Proximal humerus interlocking osteosyntheses that maintain angular stability under load have been proposed as an alternative to hemiarthroplasty for the treatment of three- and four-part proximal humeral fractures. Materials and Methods: The records showed 50 patients, with a mean age of 57.5 years. The Neer three-part proximal humeral fractures were 18 in number, and the four-part proximal humeral fractures were 32. All the patients were treated surgically between January 2008 and December 2010. All patients had a radiographic and clinical follow-up performed at one, three, and six months and at one year. The clinical outcomes were measured with the use of the Constant-Murley system. This study was based on level 1 of the evidence. Results: The mean Constant score (and standard deviation) at the time of the final follow-up was better in the locked-plate group. The mean Constant score was 80 (range, 40 - 100). Complications with this fixation included osteonecrosis in one patient, malunion in one patient, Axillary nerve palsy in one patient, and impingement syndrome in one patient. Conclusions: The most important factor for a favorable outcome in three- and four-part fractures in the proximal end humerus gives an accurate anatomical reduction, which is achieved by locking plate osteosynthesis, with multiplanar screws. It is a safe and effective method, with minimal tissue damage, higher primary stability, and load transfer through the implant, which are important to avoid complications. The PHILOS Plate produces promising functional outcomes.