Study on functional outcome of proximal humerus internal locking osteosynthesis system plating for displaced proximal humerus fractures: A prospective and retrospective study

Abstract

Background: Management of proximal humerus fractures still remains controversial. The goal of proximal humerus fracture fixation is to achieve stable anatomical reduction and to allow early mobilization. There are many methods of fixation of proximal humerus fractures. This study focuses on fuctional outcome of proximal humeral fractures fixed with Proximal Humeral Internal Locking Osteosynthesis System (PHILOS) plating.Methods: Fifty-five patients who underwent surgery with PHILOS plate for displaced proximal humerus fractures were analysed. The classification method used was Neer’s classification. All patients had a radiographic and clinical follow-up performed at one, three and six weeks, one and six months and at one and two years. The clinical outcomes were measured with the use of the Constant-Murley system.Results: Out of 55 patients, 10 patients (18%) had excellent functional outcome, 34 patients (62%) had good outcome, 8 patients (15%) had moderate outcome and 3 patients (5%) had poor outcome according to Constant-Murley scoring system. Complications were noted in 10 of 55 patients. The mean Constant-Murley score was 75.27 ± 10.56. The mean time to bone union was about 12 weeks in 90% of patients. Ten patients developed complications (18.18%) which included 1 avascular necrosis (1.82%), 3 impingements (5.45%), 2 implant failures (3.64%), 2 nonunions (3.64%) and 2 stiffness (3.64%). The mean Constant Murley score for Neer’s two-part fracture was 84.83 ± 8.77, for three part it was 79.91 ± 6.24 and for four part fracture the score was 68.52 ± 10.27. Mean Constant Murley for patients aged < 60 years was 80.73 ± 7.15 and the score for more than 60 years age was 68.72 ± 10.35. The correlation between mean Constant Murley score and Neer’s 2, 3 and 4 part fractures (p < 0.001) and age (p < 0.0001) was found to be considered statistically significant.Conclusion: Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. 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. Proper surgical technique and skills can be incorporated to avoid the complications.