What is the Single Most Important Technical Aspect When Fixing a Proximal Humeral Fracture with A PHILOS Plate?”

Abstract

Introduction: This study aimed to identify technical factors contributing to hardware complications with PHILOS plates. Methods: A five year retrospective radiological review of all PHILOS platings at our institution was performed. Pathological fractures and revision cases were excluded. (79 patients, 73 females, mean age 88 and range 15-108). AP (Antero-posterior) radiographs were used to assess infero-medial support (presence or absence of calcar screws), adequacy of reduction by measuring the neck-shaft angle, and loss of reduction. The first postoperative radiograph was compared with a follow up radiograph from more than 12 months after the index surgery and cases that required revision were identified. Six patients underwent further surgery for either screw perforation into the joint or plate failure. Cases were then divided into two groups, a revision group (R) and an unrevised group (U), and statistical analysis using Wilcoxon’s rank test for non-parametric data was performed looking at the differences between mean neck shaft angle, adequacy of reduction and loss of reduction in both groups. Results: A clinically and statistically significant difference was found in the mean neck shaft angle between the unrevised and the revised groups. The mean neck shaft angle was 129° in patients who did NOT undergo any further procedures (N = 73). The mean neck shaft angle was 110° in patients who DID undergo revision (N = 10) P <0.03. Conclusion: Restoration of an adequate neck-shaft angle was the most important determinant of successful PHILOS plate fixation. If this was not achieved, screw perforation or plate failure occurred.