Abstract
Background: Technique for the fixation of two, three, and four part proximal humerus fractures has rapidly shifted towards the use of locking plates. The objective of this prospective study was to evaluate functional outcome and complications of proximal humeral fractures managed with proximal humerus internal locking system (PHILOS). Methods: 16 men and 9 women aged 19 to 82 (mean, 49.24) with an acute proximal humerus fracture were treated with PHILOS plate by using deltopectoral approach. Outcome measurements included Constant score, and complications, and radiographic assessment. Results: 11 patients had 2-part fractures, 11 patients had 3-part fractures, and 3 patients had 4-part fractures. After 6 month follow up, a mean constant score 57.4 was achieved. Outcomes were excellent in 16%, good in 44%, fair in 16% while poor in 24%. The Constant score was poorer for Neer type IV fractures as compared to other types. The most frequently occurring complications in our patient were malreduction 20%, screw perforation 16%, infections 12%, avascular necrosis 8%, frozen shoulder 8%, impingement 4% and plate pull out 4%. Conclusion: Fixation of proximal humerus fractures with proximal humerus locking plates is associated with satisfactory functional outcomes in 2-part and 3-part fracture. The incidence of complications and subsequent re-operation is relatively high. Advanced surgical skills and surgeon’s experience are considered to be more critical for successful operative treatment. Keywords: Proximal humerus fracture, PHILOS, constant score, deltopectoral, Neer type, locking plate
Highlights
Proximal humeral fractures are recognized as an increasingly common fracture, accounting for 4%–5% of all fractures and 45% of all humeral fractures[1,2]
Total 25 consecutive adult patients of either sex with displaced proximal humerus fractures that met the criteria for operative treatment as outlined by Neer[18] i.e. an angulation of articular surface of more than 45 degrees, a displacement between the major fracture fragments more than 1 cm or a fracture with valgus impaction were included in the study
The mean age of our twenty-five patients was 49.24 (19-82), with a male: female ratio of 1.7:1 (16:9). 10 patients belong to age group more than 50 years suggesting a strong relation of proximal humerus with age related osteoporosis
Summary
Proximal humeral fractures are recognized as an increasingly common fracture, accounting for 4%–5% of all fractures and 45% of all humeral fractures[1,2]. It is the third most common fracture, in people above 65 years of age, after fractures of the hip and distal radius[3]. The remaining 15% of these are either displaced or unstable[4] These fare poorly with nonoperative treatment and are better treated with surgical intervention. Surgical treatment is necessary especially in young patients and active elderly people in order to prevent minimal dislocations of tuberosity or articular surface from compromising the long-term articular function
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