PHILOS Plate Research Articles

Comparison of Functional Outcome of Proximal Humerus Management with K-Wire versus PHILOS Plate

Background: Background: Proximal humerus fractures account for approximately 4% of all fractures and 26% of humeral fractures. While conservative treatment is often recommended, surgical management remains debated, particularly with the use of percutaneous pinning and PHILOS plating.Objective: To compare the functional outcomes of proximal humerus fractures managed with percutaneous pinning versus PHILOS plating using Constant and Murley’s score.Methods: This prospective, randomized controlled trial was conducted at Services Hospital, Lahore, over 18 months. A total of 128 patients were randomized into two groups: Group A (Percutaneous Pinning, n=64) and Group B (PHILOS Plating, n=64). Demographic data were recorded, and functional outcomes were assessed using Constant and Murley’s score at the 24th week. Data analysis was performed using SPSS 25, with independent t-tests and chi-square tests applied, considering p<0.05 significant.Results: The mean Constant and Murley score were 84.58 ± 8.561 in Group A and 86.48 ± 7.622 in Group B (p=0.186). Favorable outcomes were seen in 34.4% (n=44) in Group A and 42.2% (n=54) in Group B (p=0.037).Conclusion: PHILOS plating proved a higher rate of favorable outcomes compared to percutaneous pinning, suggesting its preferable use for proximal humerus fracture management.

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.

Comparison of the functional outcome of Philos Plate Vs. external fixator in the management of proximal humerus fracture

Background: Proximal humerus fractures, are a major medical issue that are relatively prevalent. 4-5% of all fractures are proximal humeral fractures, most of which involve older and osteoporotic individuals. Objectives: To compare the functional outcome of philos plate vs. external fixator in the management of proximal humerus fracture. Material and Methods: A retrospective comparative study was conducted at the Department of Orthopaedic Surgery, Ghurki Trust Teaching Hospital, Lahore. From November 23, 2022, to May 23, 2023. After approval from the hospital's ethical board, 112(56 per group) patients were included in the study through an emergency. Informed consent was taken from parents. We stratified patients into two groups. Group A received the treatment of Philos, while Group B received the external fixator treatment. Functional outcome was assessed at the end of 3 months postoperatively using constant shoulder score. The collected data were entered and analyzed accordingly using SPSS version 27. Results: In the current study, a total of 112 patients included underwent two surgical interventions, among these, 56 patients underwent Philos plating while an equal number of patients underwent external fixation. In Group A and B, the majority were males (37:47) out of 112. The mean age of patients was equal in both groups (Group A=44.36±11.71), and the mean age of patients was (Group A=44.88±10.05), ranging from 20 to 80 years. In Group A, the average BMI was less than 24.29±4.23, ranging from 18-35 kg/m2, compared to Group B, 28.89±3.77, ranging from 22-35 kg/m2. 38(67.9%) were effected from right side as in Group A while 41(73.2%) were effected from right side in Group B. Majoruty 28(50.0%) had history of RTA in Group A while patients 24(42.9%) were observed with history of RTA in Group B25(44.6%) cases reported excellent outcome, 6(10.7%) reported very good outcome, 16(21.4%) good, 7(12.5%) fair and 2(3.6%) poor outcome in Group A. In Group B, 36(64.3%) excellent, 7(12.5%) very good, 12(21.4%) cases reported Good and 1(1%) reported fair outcome. So it is concluded that 25(44.6%) cases reported excellent outcome in Group A, comparatively low as compared to Group B 36(64.3%). Only age was significantly associated with excellent outcomes as p<.05. Conclusion: It is concluded that External fixation demonstrated a better outcome as compared to Philos Plating, so in Orthopaedic practice, External fixation should be preferred for patients diagnosed with proximal humerus fracture to get better results and reduce the complications.

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.

A comparative study of locking plate combined with minimally invasive plate osteosynthesis and intramedullary nail fixation in the treatment of Neer classification of two-part and three-part fractures of the proximal humerus.

To compare the clinical efficacy of the minimally invasive locking plate technique (Philos plate) and interlocking intramedullary nailing technique (TRIGEN intramedullary nail) in the treatment of Neer two-part and three-part proximal humeral fractures. The clinical data of 60 patients with Neer two-part and three-part proximal humerus fractures admitted to the hospital from April 2017 to April 2021 were retrospectively analyzed. Thirty-two patients were treated with the minimally invasive locking plate technique (minimally invasive plate group), and 28 patients were treated with the interlocking intramedullary nailing technique (intramedullary nail group). The operation time, intraoperative blood loss, incision length, fracture healing time, and postoperative complications were compared between the two groups. The ASES score and Constant-Murley score were used to evaluate the shoulder joint function of the two groups one year after surgery. All 60 patients were followed up for 12 to 24months, with an average of 16months. There was no significant difference in operation time, intraoperative blood loss, incision length, or fracture healing time between the two groups (P > 0.05). The incidence of postoperative complications in the intramedullary nail group was significantly lower than that in the minimally invasive steel plate group, and the difference between the groups was statistically significant (P < 0.05). There was no significant difference in the ASES score or Constant-Murley score between the two groups one year after surgery (P > 0.05). The use of the minimally invasive locking plate technique and interlocking intramedullary nailing technique in the treatment of Neer two-part and three-part proximal humerus fractures has the advantages of a small incision, less blood loss, and a high fracture healing rate, and both can achieve satisfactory clinical effects. The internal nail technique is more convenient than the minimally invasive locking plate technique in controlling postoperative complications.

Determination of the ideal plate for medial femoral condyle fracture fixation: an anatomical fit and biomechanical study

BackgroundThe aim of this study is to determine the best plate to use as a substitute to fix a medial femoral condyle fracture.Materials and methodsThe first part is to measure the best fit between several anatomical plates including the Proximal Tibia Anterolateral Plate (PT AL LCP), the Proximal Tibia Medial Plate (PT M LCP), the Distal Tibia Medial Locking Plate (DT M LCP) and the Proximal Humerus (PHILOS) plate against 28 freshly embalmed cadaveric distal femurs. Measurements such as plate offset and number of screws in the condyle and shaft shall be obtained. The subsequent part is to determine the compressive force at which the plate fails. After creating an iatrogenic medial condyle fracture, the cadavers will be fixed with the two plates with the best anatomical fit and subjected to a compression force using a hydraulic press.ResultsThe PT AL LCP offered the best anatomical fit whereas the PHILOS plate offered the maximal number of screws inserted. The force required to create 2 mm of fracture displacement between the two is not statistically significant (LCP 889 N, PHILOS 947 N, p = 0.39). The PT AL LCP can withstand a larger fracture displacement than the PHILOS (LCP 24.4 mm, PHILOS 17.4 mm, p = 0.004).Discussion and conclusionBoth the PT AL LCP and the PHILOS remain good options in fixing a medial femoral condyle fracture. Between the two, we would recommend the PT AL LCP as the slightly superior option.

A Comparative Study of Functional Outcome Following Philos Plating Versus Percutaneous Pinning in Proximal Humerus Fractures

A Comparative Study of Functional Outcome Following Philos Plating Versus Percutaneous Pinning in Proximal Humerus Fractures

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.

To study functional and radiological outcome of proximal humerus fractures treated with Philos plate

To study functional and radiological outcome of proximal humerus fractures treated with Philos plate

Functional Outcomes of Open Reduction and Internal Fixation in Proximal Humerus Fractures by Philos Plate

INTRODUCTION Proximal humerus fractures are one very common and usually occur in elderly people. These fractures are usually associated with some degree of comminution and deformity. Therefore, good anatomical reduction of fracture fragments and early mobilization are the main component for optimal outcomes of involved limb. This study was intended to evaluate the functional outcome of proximal humerus fracture in adults managed by open reduction and internal fixation (ORIF) by proximal humerus interlocking osteosynthesis (PHILOS) plate. MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department of Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from October 2021 to September 2023. All patients with proximal humerus fractures who fulfilled the inclusion criteria and who underwent open reduction and internal fixation by PHILOS plate were enrolled in the study. Functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS In this study of 60 cases, the mean age group was 55.38±11.40 years and male patients outnumbered female patients (39 males and 21 females). 36 cases (60%) were of right side and 24 (40%) were of left side. Majority of the fractures were due to fall injury (57%) followed by road traffic accident (35%). The mean Constant Murley Score was 78.15±5.620 and VAS (visual analogue score) was 1.88±0.865. CONCLUSION Open reduction and internal fixation by PHILOS plate is an effective procedure providing good anatomical restoration and early mobilization in proximal humerus fracture thus providing good functional outcome.

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.

Cement-Augmented Screw Fixation with PHILOS Plating for Osteoporotic Proximal Humeral Fractures: An Observation of Mid- and Long-Term Curative Efficacy.

The mid- and long-term clinical outcomes of cement-augmented screws in the treatment of osteoporotic proximal humeral fractures have rarely been reported. The aim of this study was to observe the mid- and long-term efficacy of combined cement-augmented screw fixation and PHILOS plating in the treatment of osteoporotic fractures of the proximal humerus. This study retrospectively analyzed data from 19 patients with osteoporotic fractures of the proximal humerus who had undergone internal fixation at the Guizhou Provincial People's Hospital from February 2017 to May 2021. The cohort was comprised of six males and 13 females, aged 75-87 (mean age: 82.52 ± 1.24) years. According to the Neer classification, three, 12, and four patients had two-part, three-part, and four-part fractures, respectively. All patients were treated with open reduction internal fixation with cement-augmented screws and PHILOS plating. Time until fracture healing was recorded postoperatively. Patients were observed for postoperative complications, including humeral head necrosis, loosening or breaking of the augmented screws, screw perforation of the humeral head, and varus fracture displacement. Visual analog scale and Constant scores of the shoulder joint were compared 1, 3, 6, and 12 months after surgery. Scores at the most recent follow-up were used to evaluate shoulder joint function. Measured data conforming to a normal distribution were expressed as mean ± SD. Analysis of variance or rank sum tests were used for intergroup comparisons. A value of p < 0.05 was considered significant. All 19 patients followed up for 1-4 (average: 2.13 ± 0.61) years. Fractures united in all cases, with a healing time of 8-14 (average: 10.25 ± 1.72) weeks. There were no cases of humeral head necrosis, screw loosening, fractures, or perforation of the humeral head. One patient had mild varus fracture displacement with a reduced neck-shaft angle. There were significant differences in visual analog scale and Constant scores 1, 3, and 6 months after surgery (p < 0.05). The visual analog scale score was 0 at final follow-up in all cases. The Constant score of the shoulder joint was excellent, good, fair, and poor in two, 12, four, and one case, respectively, yielding an excellent and good rate of 73.68%. Cement-augmented screw fixation combined with PHILOS plating of osteoporotic proximal humeral fractures had good mid- and long-term clinical efficacy. It should be considered a new option for fracture treatment in such patients.

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.

Results of a differential approach to surgical treatment of proximal humerus fractures in patients with osteoporosis

Objective. To conduct a comparative retrospective analysis of the anatomical and functional results of surgical treatment of proximal humerus fractures AO/OTA 11-B, 11-C using different methods in patients over 50 years old with osteoporosis to justify a differential approach. Methods. The study included 102 patients aged 50 years and older with osteoporosis and proximal humerus fractures AO/OTA 11-B, 11-C. The patients were divided into three groups: I — 50 (16 men, 34 women) whom were performed open reduction and internal fixation (ORIF) with the PHILOS plate; II — 44 (8 men, 36 women) — ORIF with the PHILOS plate and using 3D polylactide (PLA) porous implants were applied; III — 8 (2 men, 6 women) whom were performed primary reversed total shoulder arthroplasty (RTSA) with developed total reversible endoprosthesis. The results of treatment were evaluated according to the Constant-Murley Shoulder Score system after 3, 6, 12 months. The results. Positive results in the first group were obtained in 72.0 % of patients (the average Constant-Murley Shoulder Score after 12 months was 78.4 points); in the second — in 81.8 % (88.0 points); in the third — 75.0 % (82.0 points). A differentiated approach to the choice of surgical treatment of patients aged 50 years and older with fractures AO/OTA 11-B, 11-C is proposed. The clinical trial of the reverse total modular shoulder endoprosthesis developed by us using porous 3D titanium parts, manufactured by additive technologies, showed positive short-term results. The design features of the device increase the reliability and durability of proposed endoprosthesis. Conclusions. RTSA in the case of unstable proximal humerus fracture or in the case of metal structure migration after primary ORIF in patients with low bone mineral density is the effective surgical intervention that allows to achieve satisfactory functional results in up to 3 years.

Predictive value of the deltoid tuberosity index for assessing the risk of screw cut-out

Abstract Background Reconstruction of the proximal humerus with a locking plate is often the first surgical approach for proximal humerus fractures. Screw cut-out is a common complication and is relevant in osteoporotic bone of older adults. The Deltoid Tuberosity Index (DTI) is an indirect measure for assessing local bone quality and failure rate before surgery, providing important information for surgical planning. This was the first independent, large-sample retrospective analysis of the correlation between local bone density, indirectly measured through the DTI, and screw cut-out. Methods In total, 306 cases of proximal humerus fractures treated with the PHILOS plate (DePuy Synthes, Oberdorf, Switzerland) were retrospectively analyzed. The DTI was measured on anteroposterior x‑rays. The primary endpoint was screw cut-out defined as the intra-articular position of at least one screw associated with a reduction loss after surgery. Results The mean clinical follow-up was 935 days. The DTI varied from 1.10 to 2.28 (average: 1.45). Screw cut-out occurred on average in 8% of the cases and was positively correlated with a DTI of ≤ 1.44 (p = 0.003). However, the rate of cut-out and correlation with DTI varied widely according to age group: for ages 65–80 years, a DTI of ≤ 1.44 increased the cut-out rate from 0% to 17% (p = 0.02); in younger ages (&lt; 65 years) the DTI did not correlate with cut-out and in the oldest group (&gt; 80 years) cut-out rates were high (17–20%) independently of the DTI. Conclusion We confirm the correlation between a DTI of ≤ 1.44 and screw cut-out. High-risk groups for screw cut-out are patients over 65 years with a DTI of ≤ 1.44 or any patient older than 80 years. Applying the DTI in the age group of 65–80 years offers relevant information for surgical planning in the trauma setting via a fast, cheap, and easy-to-use tool. Level of Evidence: Level 3, Retrospective Cohort Study.

HELICAL VERSUS STRAIGHT PLATING OF PROXIMAL THIRD HUMERAL SHAFT FRACTURES - A BIOMECHANICAL STUDY

Proximal humeral shaft fractures are commonly treated with long straight locking plates endangering the radial nerve distally. The aim of this study was to investigate the biomechanical competence in a human cadaveric bone model of 90°-helical PHILOS plates versus conventional straight PHILOS plates in proximal third comminuted humeral shaft fractures.Eight pairs of humeral cadaveric humeri were instrumented using either a long 90°-helical plate (group1) or a straight long PHILOS plate (group2). An unstable proximal humeral shaft fracture was simulated by means of an osteotomy maintaining a gap of 5cm. All specimens were tested under quasi-static loading in axial compression, internal and external rotation as well as bending in 4 directions. Subsequently, progressively increasing internal rotational loading until failure was applied and interfragmentary movements were monitored by means of optical motion tracking.Flexion/extension deformation (°) in group1 was (2.00±1.77) and (0.88±1.12) in group2, p=0.003. Varus/valgus deformation (°) was (6.14±1.58) in group1 and (6.16±0.73) in group2, p=0.976. Shear (mm) and displacement (°) under torsional load were (1.40±0.63 and 8.96±0.46) in group1 and (1.12±0.61 and 9.02±0.48) in group2, p≥0.390. However, during cyclic testing shear and torsional displacements and torsion were both significantly higher in group 1, p≤0.038. Cycles to catastrophic failure were (9960±1967) in group1 and (9234±1566) in group2, p=0.24.Although 90°-helical plating was associated with improved resistance against varus/valgus deformation, it demonstrated lower resistance to flexion/extension and internal rotation as well as higher flexion/extension, torsional and shear movements compared to straight plates. From a biomechanical perspective, 90°-helical plates performed inferior compared to straight plates and alternative helical plate designs with lower twist should be investigated in future paired cadaveric studies.

A PROSPECTIVE OBSERVATIONAL STUDY ON FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES FIXED SURGICALLY WITH PHILOS

Proximal humerus fractures are common injuries that can result in signicant functional disability. The use of the PHILOS plate in surgical management of these fractures has gained popularity due to its ease of use and favourable biomechanical properties. This paper aims to assess the functional outcomes of surgical management of proximal humerus fractures xed with the PHILOS plate. The methodology involved studying patient demographics, fracture classication, surgical technique, postoperative protocol, and complications. The study found that surgical management of proximal humerus fractures with the PHILOS plate results in good functional outcomes, with a low complication rate.

AN INVESTIGATIONAL CASE STUDY ON MDMAAND ATRACURIUM INDUCED MALIGNANT HYPERTHERMIA

A 27 year old male was scheduled to undergo open reduction and internal xation (ORIF) with PHILOS plate for left shoulder proximal humerus fracture. Aneasthesia was induced with atracurium. Patient developed tachycardia and fall in saturation within 20 minutes, which was managed conservatively and procedure was continued. During intraoperative period patient developed muscle rigidity on left hand along with hypotension and hyperthermia, which confused the surgeon and anesthesiologist whether it is attributed to the drug or some other genetic factors. Patient underwent rst episode of cardiac arrest after 45 minutes induction of general anaesthesia. He was resuscitated but developed second episode of cardiac arrest after a few minutes. Patient was shifted to MICU, all supportive and resuscitation measures were given. Despite all resuscitative measures, patient could not be revived and expired on post op day 2. Later on postmortem report revealed presence of 3,4- methylenedioxymethamphetamine (MDMA) in blood and body uids. There has only been one evidence of atracurium induced malignant hyperthermia reported before, but the probablity of devoloping hyperthermia in this case was probably high. The aim of this study was to investigate whether MDMAor Atracurium is a trigger of malignant hyperthermia in this patient

Biomechanical analysis of helical versus straight plating of proximal third humeral shaft fractures.

Proximal humeral shaft fractures are surgically challenging and plate osteosynthesis with a long straight plate is one operative treatment option in these patients although endangering the radial nerve distally. Helical plates potentially avoid the radial nerve by twisting around the humeral shaft. Aim of the study was to investigate in a human cadaveric model the biomechanical competence of helical plates versus straight lateral plates used for fixation of proximal third comminuted humeral shaft fractures. Eight pairs of humeral cadaveric humeri were instrumented using either a long 90°-helical plate (Group1) or a straight long PHILOS plate (Group2). An unstable proximal humeral shaft fracture was simulated by means of a 5cm osteotomy gap. All specimens were tested under quasi-static loading in axial compression, internal and external rotation, and bending in four directions. Subsequently, progressively increasing cyclic loading in internal rotation until failure was applied and interfragmentary movements were monitored by motion tracking. During static testing flexion/extension deformation in Group1 was significantly higher, however, varus/valgus deformation as well as shear and torsional displacement under torsional load remained statistically indifferent between both groups. During cyclic testing shear and torsional displacements were both significantly higher in Group1 compared to Group 2. However, cycles to catastrophic failure remained statistically indifferent between the groups. From a biomechanical perspective, although 90°-helical plating is associated with higher initial stability against varus/valgus collapse and comparable endurance under dynamic loading, it demonstrates lower resistance to flexion/extension and internal rotation with bigger shear interfragmentary displacements versus straight lateral plating and, therefore, cannot be considered as its real alternative. Alternative helical plate designs should be investigated in the future.