Philos Plate Fixation Research Articles

Assessing Functional Outcome of PHILOS Plate Fixation in Proximal Humerus Fractures- A Prospective Study

Introduction: Despite the availability of numerous treatment options, managing unstable proximal humeral fractures remains a significant surgical challenge. Utilizing a PHILOS plate is an effective surgical technique for addressing these fractures. This approach provides stability and support to the fracture site, promoting proper healing and potentially improving patient outcomes. Aim of the study: The aim of this study was to assess the functional outcome of PHILOS plate fixation in proximal humerus fractures. Methods: This prospective study was conducted in the the Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka, Bangladesh during the period from January 2009 to December 2010. A total of 80 patients aged over 18 years were included in the study. Patients with open, pathological and ipsilateral distal fractures in the same limb were excluded from the study. Result: The youngest and the oldest one were 23 and 78 years respectively. Majority of the patients were male and business was their main occupation. Fifty patients (62.5%) presented with 3-part fractures, ten (12.5%) with four-part fractures and twenty (25%) with fracture dislocation. The interval between injury and plate fixation was 18 days and minimum and maximum interval was 2 and 78 days respectively. Majority (92.5%) of the injury was caused by high-velocity accident. Evaluation of the outcome at 6 months showed that 62.5 percent of patients had good outcome, 25 percent patients had fair outcome. Conclusion: PHILOS plate fixation for proximal humeral fractures provides stable fixation and good functional outcomes, particularly in elderly patients.

A comparative study of functional outcome of percutaneous kirschner wire fixation versus philos plating of proximal humerus fractures

: Proximal humerus fractures, accounting for approximately 5% of all fractures, pose a significant challenge in orthopedic management due to their complex anatomy and diverse fracture patterns. Treatment options range from conservative methods to various surgical interventions, each with its pros and cons. This study specifically compares two commonly employed surgical techniques: Open reduction & internal fixation with PHILOS plate and percutaneous k-wire fixation with/without external clamps. This study aims to address the effectiveness of each technique by evaluating functional outcomes using validated scoring systems like the Constant-Murley Score. To assess the functional outcomes of two surgical treatment methods (K-wire application and PHILOS plate fixation) for proximal humerus fractures. : A randomized prospective study was conducted on patients coming to the Orthopaedics outpatient department or casualty of tertiary care hospital for a duration of 1 year from Dec 2022 to Nov 2023. A total of 18 patients were included in the study. The mean Constant- Murley Score (CMS) was 81 +/- 6.13 for the PHILOS plating group and 76.88 +/- 7.37 for the K-wire treated group with a p-value of 0.08. The results for CMS were excellent in 22.2% of patients and good in 66.7% of patients in PHILOS treated group and excellent for 11.11%, good for 66.67% and satisfactory for 22.2% in the K-wire treated group. Both groups achieved satisfactory functional outcomes with CM Score at the final follow-up. Both techniques achieved favorable outcomes, with a majority of patients in both groups (88.89% for PHILOS and 77.78% for K-wire) achieving good to excellent results based on the CMS scores.

Novel calcaneal plate versus traditional philos plate for treating split fractures of humeral greater tuberosity.

To compare the effect of two internal fixation methods of calcaneal plate fixation and Philos plate fixation in treating split fractures of humeral greater tuberosity. A total of 37 patients with split fractures of humeral greater tuberosity were retrospectively analyzed from September 2016 to April 2021. Enrolled patients were divided into Group A (calcaneal anatomical locking plates), and Group B [Proximal Humeral Internal Locking System (PHILOS)]. The demographics, injury-related variables, surgery-related variables, Constant-Murley score, and postoperative complication between the two groups were compared. There were 16 in Group A and 21 in Group B. Fracture union was achieved in all patients, with an average of 11.9 months. The mean length of incision was significantly different between groups (Group A, 6.16 cm ± 1.07 cm; Group B, 9.09 cm ± 1.30 cm, p < 0.05). Significant difference was observed by comparing bleeding loss between Group A and Group B (Group A, 45.41 ± 11.19 ml; Group B, 106.06 ± 11.12 ml, p < 0.05). After 6 months of treatment, the average Constant-Murley score of Group A was significantly higher than that of Group B (p < 0.05). In terms of operation, no significant difference was observed between groups. In addition, two patients had shoulder impingement syndrome in Group B, and none in Group A. Calcaneal anatomical locking plate fixation is superior to Philos plate fixation in surgical trauma and bleeding loss. Our study provides an alternative technique for treating split fractures of humeral greater tuberosity.

Biomechanics of PHILOS plates in Vancouver B1 periprosthetic femoral fracture.

Objective: To investigate the clinical efficacy of PHILOS plates in the treatment of Vancouver B1 periprosthetic femoral fracture (PFF) and to validate its biomechanical reliability via finite element analysis and mechanical testing on the Synbone femoral models. Methods: Ten males and eight females with Vancouver B1 PFF who underwent PHILOS plate fixation between September 2017 and January 2022 were selected. The average age was 72.61 ± 8.19years, with a range of 57-86years old. X-ray films were taken to assess the fracture healing situation around the femoral prosthesis as well as the position of the PHILOS plates and femoral prosthesis. Two different plates (the PHILOS plate and the Cable GTR plate) were used for fixation, and the differences in biomechanical stability of the two fixation methods were compared using finite element analysis and mechanical testing on the Synbone femoral models to validate the biomechanical dependability of the PHILOS plate. Results: All 18 cases were followed for at least 1year, as a result. The average period of follow-up was 17months, ranging from 12 to 36months. At the most recent follow-up, Harris scores for the hip joints of patients ranged from 82 to 89, with an average score of 86. The X-rays revealed that all fractures surrounding the femoral prosthesis had healed and that there was no looseness in the femoral prosthesis. None of the PHILOS license plates had expired. All patients were able to perform full-load walking, and pain and claudication in affected limbs were significantly reduced. Finite element analysis and mechanical testing of the Synbone femoral model revealed that the fixation effect of the PHILOS group was superior to that of the Cable group; consequently, PHILOS plates can be used to effectively fix fractures around the proximal femoral prosthesis. Conclusion: PHILOS plates are initially used in the treatment of Vancouver B1 PFF, which may be a good choice due to their simpler operation, lower medical costs, and satisfactory clinical efficacy.

Lateral minimally invasive plate osteosynthesis (MIPO) with long PHILOS for proximal metaphyseal-diaphyseal humeral fracture: surgical techniques and a clinical series.

The minimally invasive plate osteosynthesis (MIPO) for proximal metaphyseal-diaphyseal humeral fracture is an effective alternative treatment with satisfactory outcomes. In this study, we described the surgical techniques and clinical results using MIPO via a lateral approach and long PHILOS plate fixation in 23 patients. All fractures were successfully united within a mean union time of 13.5weeks (range 9-18). There was no iatrogenic radial nerve palsy. The deltoid power was grade 5 in all patients, except for 2 patients who had associated brachial plexus injury and gunshot injury at the deltoid muscle. The mean Constant-Murley score was 85.6 (range 16-98) and DASH score was 12.1 (range 1.7-85). Based on these findings, the lateral MIPO with long PHILOS plate fixation could be an alternative for the proximal metaphyseal-diaphyseal fractures of the humeral shaft.

Fibular Autograft as Medial Support with Proximal Humerus Locking Plate Construct in Comminuted Proximal Humerus Fractures: A Retrospective Analysis.

Varus collapse is one of the pivotal mechanisms of failure following surgical fixation of proximal humerus fractures. The aim of the present study was to evaluate functional and radiological outcomes of non-vascularized fibular autograft as medial support with locking plate construct for comminuted proximal humerus fractures (PHF's). We retrospectively evaluated 18 patients with unstable PHF's in the age group 50-70years with a minimum follow-up of two years. All thefracture patterns were classified according to Resch, Neer's and AO classification and either medial calcar compromise or comminution were present in all. Open reduction internal fixation (ORIF) with a locking plate was performed for all thepatients along with intramedullary fibular autograft to support medial calcar. Radiological outcome was assessed by neck-shaft angle (NSA) graded according to the Paavolainen grading method and difference in thehumeral head height (HHH). Functional outcome was assessed by shoulder range of motion (ROM), University of California-Los Angeles (UCLA) score and American shoulder and elbow surgeons score (ASES). Radiological union at the fracture site was achieved in all the patients at mean of 8months (range 6-12months). Range of movements were mean flexion of 123.89, extension 35.28, internal rotation 66.94, external rotation 57.78 and abduction of 115° at final follow-up. The average NSA was in the range of 120°-130° and none of the patients showed difference in HHH of ≥ 4mm in the immediate post-operative radiograph and that taken on final follow-up. The functional outcome assessed by ASES score (mean 89.44) and UCLA score (mean 29.61) suggested fair to good results. None of the patients has shown varus collapse and avascular necrosis. Neither there were any complications related to the donor area. In unstable proximal humerus fractures with calcar comminution or void, PHILOS plate fixation augmented with fibular autograft as a medialsupport reduces varus collapse and promotes early radiological union.

A Transosseous Suture as an Alternative to Suture Anchor on Anterior-Avulsion Greater Tuberosity Fragment Fixation in Neer Three-Part Proximal Humeral Fracture: A Biomechanical Study.

Greater tuberosity (GT) fragments were communicated, and additional techniques to increase the GT fragment stability after the locking plate fixation was necessary. This study aimed to analyze the reinforcement effects on the anterior-avulsion GT fragment in Neer three-part proximal humeral fractures (PHFs) using transosseous suture and suture anchor techniques. Eighteen fresh-frozen human cadaveric shoulder specimens were used in the study. Standardized fracture of the GT and surgical neck was created in 18 human cadaveric proximal humerus. The GT fragments were reinforced with transosseous suture (TS), suture anchor (SA), and suture in addition to the PHILOS plate fixation. The fixed humerus was tested by applying static loading to the supraspinatus tendon. Load forces and fragment displacement were evaluated by a biomechanical testing machine, and the load to 3- and 5-mm displacements, load to failure, and mode of failure were recorded for all specimens. Nonparametric variables were examined by the Kruskal-Wallis test, and the Bonferroni post hoc test was used to analyze the mean loads to create 3- and 5-mm displacements as well as the failure load. The age, female proportion, and bone mineral density showed no statistically significant differences between the three groups. The mean loading force to create 3-mm and 5-mm displacement in the TS group (254.9 ± 77.4, 309.6 ± 152.7) were significantly higher than those in the suture group (136.1 ± 16.7, 193.4 ± 14.5) (P=0.024, P=0.005). For the SA group, the force to create 3- and 5-mm displacement (204.3 ± 60.9, 307.8 ± 73.5) were comparable to those in the TS group (P = 0.236, P=0.983). Moreover, the loading force to failure in the TS group (508.6 ± 217.7) and SA group (406.6 ± 114.9) was significantly higher than that in the suture group (265.9 ± 52.1) (P=0.021, P=0.024). In the TS group, three failed due to tendon-bone junction rupture; bone tunnel broken occurred in two specimens; suture rupture could also be seen in one specimen. All specimens in the suture group failed because of suture rupture. In the SA group, three specimens failed due to suture rupture; two failed secondary to tendon-bone junction rupture; and one failed because of shaft fracture. Transosseous suture is a new type of reinforcement for GT fragment in Neer-three part PHFs. The transosseous suture was superior to the suture only in the reinforcement of the anterior-avulsion GT fragment of Neer three-part PHFs, and it had comparable biomechanical strength to the suture anchor.

MANAGEMENT OF PROXIMAL HUMERUS FRACTURE IN ADULTS WITH PHILOS PLATE FIXATION IN NEER TYPE 2 AND TYPE 3

Introduction: One of the most frequent bone fractures is a fracture of the proximal humerus. They make up between 4% and 5% of all fracture. With less invasive soft-tissue injury and a lower risk of iatrogenic avascular necrosis, closed reduction and percutaneous fixation have become more popular in recent years as opposed to open reduction (OR) and extensive internal fixation (IF) (by plates and screws). Aim: The aim of this study was to compare the functional results of proximal humerous locking osteosynthesis (PHILOS) fixation against OR and IF of proximal humerus fractures (2 and 3 Neer’s classification). Methodology: This study involved 40 patients, with a mean age of 53 and a range of ages from 18 to 55, with 2 and 3 part fractures according to Neer’s classification. Patients were randomized to either group, with Group I type 2 fractures receiving OR and IF for 22 patients, and Group II (type 3 fractures) with 18 patients receiving PHILOS plate fixation, with function assessed using the CMS score. Results: At 1 month, 3 months, and 6 months of follow-up, Group I’s mean Visual analog scale (VAS) score decreased to 2.52, 2.10, and 1.22 and in Group II, 3.86, 2.64, and 2.41. The VAS score was reduced and function CMS score were significantly increased in Group I (80% VAS score, 65% CMS score) as compared to Group II (64% VAS score, and 58%CMS score). At 1, 3, and 6 months, there was a statistically significant difference between the two groups. Conclusion: Both groups saw satisfactory results, with each method having benefits and drawbacks. We discovered that plate fixation provided stable fixation with few implant problems and early range-of-motion exercise to achieve acceptable functional results.

Minimally invasive plate osteosynthesis for segmental humerus fractures with a helical plate. Which distal fixation—the anterior or lateral—is superior?

Aim: In order to achieve adequate stability in segmental humerus fractures, the PHILOS fixation with minimal invasive approach comes into use instead of conventional plating. However, according to the AO classification, 12C type segmental humerus fractures treated with minimally an invasive method are prone to complications. The purpose of this prospective study is to compare functional outcomes and complication rates following two different angled helical PHILOS plate fixation. Material and Method: This multicenter study is a prospective review of cases with a final follow-up outcome. Twenty-two patients with AO 12-C humerus fractures underwent PHILOS fixation with contoured PHILOS plates between January 2016 and June 2019. Patients evaluated in two groups. Group 1 consisted 12 patients who were treated with a 30° helical plate and Group 2 consisted 10 patients who were treated with 70° helical plate. Clinical outcomes were noted according to the Constant-Murley scoring system. Results: The mean age of patients treated in groups 1 and 2 were 49±15.8 and 50.7±17, respectively. Fractures healed in an average of 13.1±3.9 weeks in Group 1 and 13.8±3.1week in Group 2, respectively. The mean follow-up period of the patients was 18±6.1months in Group 1 and 22±4.2 months in Group 2. Mean Constant-Murley scores at final follow-up were 88±2.7 and 90±2.5 in Groups 1 and 2 respectively (p=.665). Radial nerve neuropraxia was seen in 2 cases in Group 1, and a sensorial injury of the musculocutaneous nerve was seen in 1 patient in Group 2 (p=.365). Conclusion: Similar union rates and successful clinical results were obtained from both groups. However, this study suggests that the 70° angled helical PHILOS technique could be performed relatively easily in AO 12-C fractures with fewer complication rates. Musculocutaneous nerve affliction can be as functionally destructive as radial nerve affliction.

A comparative study to assess the functional outcome in proximal humerus fractures treated surgically with philos plate (Proximal humerus internal locking system) and percutaneous k-wire fixation

Background: Proximal humerus fractures are common and debilitating injuries and incidence of them are increasing especially in elderly. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains challenging. Significant controversy continues regarding the best methods of treating displaced proximal humerus fractures. Fracture classification has been inconsistent and surgical treatment have been variable. Most studies indicate that for the majority of good results of fractures of this region are obtained by conservative methods. Some studies state that operative treatment is better, depending on type of fracture and the quality of the bone. This present study is aimed to assess the functional outcome in proximal humerus fractures treated surgically with PHILOS (Proximal Humerus Internal Locking System) plate and percutaneous K-wire fixation in the indicated group of patients. Aim: To assess the functional outcome in proximal humerus fractures treated surgically with PHILOS (Proximal Humerus Internal Locking System) plate and percutaneous K-wire fixation in the indicated group of patients. Methods: This is a prospective study, period from December 2019 to August 2021, and a minimum of 50 sites of proximal humerus fractures were attended in the casualty and OPD were evaluated clinically and radiographically. Results: Functional assessment using NEER’s score was found to be significantly more in group A subjects as compared to group B subjects at 6 weeks, 12 weeks and 6 months. At 6th week, TRU score was found to be significantly more in Group B subjects as compared to Group A subjects.

Assessment of Functional Outcome of Surgical Management of Proximal Humerus Fracture Treated with PHILOS Plate

Background: This study is conducted to evaluate the results in terms of functional outcome of proximal humeral fractures treated by anatomic locking compression (PHILOS- proximal humerus interlocking system) plate.&#x0D; Methods: This prospective study was a study on patients with fracture of proximal humerus. Patients who fulfilled the inclusion criteria were invited to participate in the study. Informed consent was obtained from all the patients willing to participate in the study.&#x0D; Results: The average constant and murley score after 6 weeks was 33.34 point, after 3 month it was 54.02 points and after 6 month it was 73.6 point . For the same time zones the mean score for type A was 37.47 , 58.35, 77.12, for type B was 34.64, 55.95, 75.69 and for type C was 33.44, 54.14, 73.71 at 1.5, 3 and 6 month respectively.&#x0D; Conclusions: Philos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and is a feasible option.&#x0D; Keywords: Philos plating, Proximal humerus fractures, Shoulder fractures

A comparative study of surgical management of surgical neck of humerus fracture in adults by proximal humeral nailing and PHILOS

Fractures of surgical neck of the humerus represent 25% of the proximal part of humerus. Neer described three types of fracture of the surgical neck: angled, translated/separated and comminuted. Proximal humeral nail and PHILOS plate fixation for the surgical neck of humeral fractures offers good anatomic fracture reduction and stable primary fixation to ensure rapid fracture healing and imme­diate post-operative functional therapy without prolonged immobilization. Objective: To assess and compare the functional outcome and the fracture union of surgical neck of humerus fractures using proximal humeral nail and PHILOS plate. Material and Method: Prospective Comparative study was conducted at Bapuji and Chigateri General hospital attached to JJM Medical college, Davangere for a period of two years from July2018 to July 2020.60 adult patients with surgical neck of humerus fractures who were willing for surgery were admitted during the period of study and followed up for 12 months. Result: In our study most patients were Female (60%) out of 60 patient. The mean age being 58 years in Group1 and 47.66 years in Group 2. Most of the case were road traffic accident comprising of 65% in Group 1 and self fall 63% in Group 2. In this study,70% of the patients presented with 2-part fracture, 30% with 3-part fracture in Group 1 and 50% of each fracture pattern in Group 2. In this study, according to Neer’s score of patients had excellent 9(30%), satisfactory outcome 17(56.66%), and unsatisfactory outcome 4(13.33%) in Group 1 patients and, excellent result in 6(20%) cases, 20 cases (66.66%) had satisfactory outcome and unsatisfactory outcome 4(13.33%) in Group 2. Conclusion: Surgical neck of humerus treated with PHN offers minimally invasive, cosmetically acceptable scar, stable and axial fixation with minimal soft tissue damage, early mobilization, where as in PHILOS provide rigid and stable fixation in most of communited fractures.

A study of prospective analysis of outcome of proximal humerus fracture with philos plate fixation

Introduction: Proximal humerus fractures constitute 5% of all fractures. These fractures are common in elderly patients presenting as a challenging problem in the management because of the low-quality of cancellous bone. Aim: The study aims to evaluate the outcome of proximal humerus fractures managed with PHILOS. Methods: This prospective study to determine the outcome of proximal humerus fractures treated with PHILOS. 40 patients were taken for this study. Preoperative workup was done to exclude open fractures. Majority of fracture fixation was done through a deltopectoral approach. Fracture fixation was done with the PHILOS plate under ‘C’ armcontrol. All patients were reviewed clinically and radiologically at regular interval. Results: Type of fractures according to Neer’s classification 22 were two parts, 8 three parts and 10 four parts. Excellent results were in 26 cases, good results in 9 cases, fair results in 5 patients and there were no poor results. Fair results were in four parts fractures with intraarticular extensions. Conclusion: PHILOS fixation gives excellent results in proximal humerus fractures, and it provides rigid fixation in early mobilization. However, we are aware that this is a short term study and would require further evaluation and more input.

Study of surgical management of fracture of proximal humerus by PHILOS plate and screws

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Proximal humerus fracture accounts for about 5% of all fractures in recent advances proximal humerus fractures are often managed operatively with PHILOS plate which provides greater angular stability and study was aimed at to assess functional outcome of PHILOS plate fixation in proximal humerus fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study of 31 cases of proximal humerus fractures admitted and operated in Kempegowda Institute of Medical Sciences Hospital November 2017 to May 2019 of which 4 patients died due to medical comorbidities so 27 patients were studied. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Constant and Murley (CM) scoring and disabilities of the arm, shoulder and hand (DASH) scoring.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; CM scoring and DASH scoring was applied to analyze the functional outcome among the cases. Most of the patients had excellent outcome (52%) followed by good (26%), fair (8%) and poor (15%) outcome according to CM scoring and according to DASH scoring 20.21 was mean score and mean CM score was 77.62. Complications observed were impingement in 1 patient, avascular necrosis in 2 patient and non union in 1 case.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude that the use of PHILOS plate for the fixation of proximal humerus fractures is a good device as it provides rigid fixation and early mobilisation and prevented complications. Precontoured locking plates work on the principle of angular stability, divergent screws, less disruption of vascularity and less chances of plate failure.&lt;/p&gt;

Screw configuration in proximal humerus plating has a significant impact on fixation failure risk predicted by finite element models

Proximal humeral fractures occur frequently, with fixed angle locking plates often being used for their treatment. No current quantitative evidence for the effect of different screw configurations exists, and the large number of variations makes biomechanical testing prohibitive. Therefore, we used an established and validated finite element osteosynthesis test kit to quantify the effect of variations in screw configuration on predicted failure risk of PHILOS plate fixation for unstable proximal humerus fractures. Twenty-six low-density humerus models were osteotomized to create malreduced unstable 3-part fractures that were virtually fixed with PHILOS plates. Twelve screw configurations were simulated: 6 using 2 screw rows, 4 using 3 rows, and 1 with either 8 or 9 screws. Three physiological loading cases were modeled and an established finite element analysis methodology was used. The average peri-screw bone strain, previously demonstrated to predict fatigue cutout failure, was used to compare the different configurations. Significant differences in peri-screw strains, and thus predicted failure risk, were seen with different combinations. The 9-screw configuration demonstrated the lowest peri-screw strains. Fewer screw constructs showed lower strains when placed further apart. The calcar screws (row E) significantly (P < .001) reduced fixation failure risk. Screw configurations significantly impact predicted cutout failure risk for locking plate fixations of unstable proximal humerus fractures in low-density bone. Although requiring clinical corroboration, the result of this study suggests that additional screws reduce peri-screw strains, the distance between them should be maximized whenever possible and the calcar screws should be used.

Surgical Treatment of the Displaced Proximal Humeral Fractures in Adults with Philos Plate

Aim: To evaluate the treatment outcome of Philos plate fixation for displaced proximal humeral fractures in 17 patients.&#x0D; Methods: This was a prospective study with 17 patients, 11 women, 6 men with average age 62yr having displaced proximal humeral fractures fixed with Philos plate. All the fractures were closed and no associated injuries, classified as 2 part (n=12),3 part (n=3),4part (n=2) according to Neer classification. All patients were evaluated clinically, functionally and radiologically using the Constant Shoulder Score.&#x0D; Results: Patients were followed up for 6 to 24 months. All the fractures healed except one which was four part fracture in 65yr woman. The fracture was in varus position and screw penetration of humeral head at six week. Revision surgery was done and eventually fracture united.&#x0D; Conclusion: Philos plate fixation is a good stable construct with minimal metal work problems and permit early movement J&#x0D; Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 80-82

Assessment of functional outcome of surgical management of proximal humerus fracture treated with PHILOS plate

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Proximal humeral fractures were treated conservatively in the past and often had compromised functional results. With the advancement of surgical techniques, these fractures, especially displaced, are now more often managed operatively; to meet the needs of the patient, provide early rehabilitation and better functional outcome. The aim of this study was to assess the functional outcome of operative management of proximal humeral fractures with Philos plate fixation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this prospective study, 30 patients aged 19-75 years (mean age 47.1 years) with fractures of the proximal humerus, including two-, three-, and four-part fractures, were treated by open reduction internal fixation with Philos plating. Patients’ functional outcomes were evaluated based on subjective (35 points) and objective (65 points) parameters, as per the constant scoring system.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Functional outcome based on the constant scoring system of the patient at 6 month follow-up were compared. Excellent results were seen in 12 patients (40%), 2 had very good results (6.66%), 9 patients were having good (30%) and 6 had fair (20%) functional outcome. One patient had poor functional results (3.33%). Avascular necrosis (AVN) of the humeral head was observed in one patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Philos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and is a feasible option.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Functional outcome of Philos plate fixation in proximal humerus fractures

Background: Conservative treatment for Proximal humeral fractures were common in the past and often had compromised functional results. With the advancement of surgical techniques, proximal humerus fractures are now more often managed operatively for early rehabilitation and better functional outcome. The aim of this study was to assess the functional outcome of PHILOS plate fixation in proximal humerus fractures. Materials and Methods: A prospective, non-controlled, non-randomized study was conducted on patient admitted in our institution between July 2016 and August 2017 with displaced proximal humeral fractures with mean age of 50 years (range 24-75years). 15 patients were selected for the study. The outcome was assessed based on Constant-Murley score. Results: Results were analysed according to Constant-Murley score. Excellent results were achieved in 3 (20%), good results in 7 (46.66%), fair results in 3 (20%) and poor result in 2 (13.33%) of the cases. Avascular necrosis (AVN) and non-union was observed in one patient. Conclusion: PHILOS plate fixation for proximal humeral fracture is a good stable fixation with a good functional outcome especially in osteopenic elderly patients

A comparative study of closed reduction and fixation with percutaneous k-wires versus open reduction and internal fixation with philos plate for proximal humerus fractures in the elderlyDr. Kumar Anshuman and Gourishankar Patnaik

The aim of this study is to compare and evaluate functional, clinical and radiological outcome achieved by open reduction and internal fixation by Philos plate & percutaneous k-wire fixation of proximal humerus fracture in the elderly patients. In conclusion, locking Compression plate has a distinct advantage in treatment of proximal humeral fractures. This is due to angular stability, compression of fragment particularly in comminuted fractures and in Osteoporotic bones in elderly patients, thus allowing early mobilization. Percutaneous k-wire fixation can be a viable option in elderly patients where several comorbidities. They are particularly useful where we are dealing with patients who have constraint of finances and anesthestic risks of long hours of surgery.

Factors Influencing Functional Outcome of Philos Plate Fixation for Proximal Humerus Fractures

Introduction: Displaced and unstable proximal humerus fractures are difficult to treat and they have high morbidity. The main goal is to achieve painless shoulder with full recovery of the shoulder joint motion. Impingement syndrome is one of the commonest postoperative complication. This study aim is to appreciate the functional outcomes of Philos-plate fixation for proximal humerus fractures and to establish association with high plate positioning with impingement syndrome of the shoulder after Philos-plate fixation. Materials and method: This is a retrospective study, reviewing 26 patients who had proximal humeral fractures and underwent open reduction and Philos-plate fixation between December 2010 and January 2015 in Hospital Tengku Ampuan Afzan, Kuantan. Preoperative X-rays or CT scans were inspected, follow-up visits and X-ray images were obtained at every follow-up to evaluate the plate position and bone union. Assessments of impingement syndrome and other complications were done and also functional outcome measured with Constant shoulder scoring system during final follow-up. Results: Almost 70% of patients achieved good (Constant score: 71-85) to excellence (Constant score: 86-100) outcome, with 77.54 mean Constant score. All cases achieved union. None of the cases developed complications like malunion, infection, AVN, and loosening of implant while 2 cases complicated with shoulder impingement post operatively. Among all the factors, age more than 60 years, and high plate position found to be a significant factor in the outcome of the surgery where both factors yielded significantly less mean Constant scores. Neer 3 parts fractures have higher mean of Constant score compare to Neer 4 parts fractures and high plate position is significantly associated with impingement syndrome postoperatively. Conclusion: This study showed that age, fracture type and plate position were key factors affecting shoulder function after Philos locking plate fixation surgery. We recommend that plate should be position at most 10mm from the greater tubercle to prevent impingement syndrome postoperatively and for better functional outcome.