Proximal Humerus Internal Locking System Plate Research Articles

TREATMENT OF PROXIMAL HUMERUS FRACTURES USING PHILOS PLATE: A RETROSPECTIVE REVIEW OF RECORDS IN A TERTIARY CENTER IN NEPAL

Introduction Treatment of proximal humerus fractures always holds a dilemma for the treating surgeon. Many treatment options are available for its management. This retrospective review of records aimed to assess the functional outcome of proximal humerus fractures treated with Proximal Humerus Internal Locking System (PHILOS) plating. Fifty-three consecutive patie Material and Methods nts were treated with PHILOS plating between August 2019 to August 2021. Adults 18-65 years with displaced closed fracture proximal humerus (displacement >1 cm and varus angulation of >45) who underwent xation with PHILOS plate were included in this study. Severely comminuted fractures, open fractures and valgus impacted fractures were excluded from the study. Patients with additional injuries to ipsilateral limb and other systems were also excluded. Neer's scoring system was recorded for visit at 3,6 and 12 weeks The average Results age was 54.3±5.8 years. As per the Neers classication system, there were 6 (11.32%) 1-part, 19 (35.85%) 2-part, 17 (32.085) and 11 (20.75%) 3 and 4-part fracture respectively. Average surgical duration was 94±10.2 minutes. Radiological union was seen at 12±4.6 weeks. There were 2 (3.77%) cases of varus collapse. Three (5.66%) cases had screw back out, which was later revised and had a favorable outcome. As per the Neer's scoring system, 7 (13.21%) cases had excellent results, 37 (69.81%) had satisfactory, 6 (11.32%) had unsatisfactory while 3 (05.66%) cases had poor outcomes. PHILOS plating has a good Conclusion functional outcome. However, proper patient selection, thorough knowledge of the anatomy and biomechanical principles are the pre-requisites for a successful surgery.

COMPARATIVE STUDY SHOWING FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURE FIXATION WITH PHILOS PLATING V/S PERCUTANEOUS K-WIRE FIXATION.

Background: There is still a lot of debate, regarding the most effective ways to treat displaced proximal humerus fractures. Numerous xing techniques been developed for proximal humerus fractures (like percutaneous pinning, tension band wiring, screw xation, conventional plate, T buttress plate, locking plate, prosthetic replacement). Close reduction & percutaneous k-wire xation having advantage being minimal invasive, less soft tissue stripping, with less blood loss, hence useful in elderly patients. But implant of choice for treating displaced proximal humerus fractures is locking plate because it provides absolute anatomical xation with angular stability. This study evaluates prospectively, the functional outcome following PHILOS vs percutaneous pinning in proximal humerus fractures. 30 patie Methods: nts were enrolled for study based on OPD & trauma centre admissions based on inclusion & exclusion criteria. Patients were grouped into two groups based on consecutive sampling. Group A (15 Patients) {ODD} includes rst patients, Group B (15 Patients) {EVEN} includes second patients. Group A operated with proximal humerus internal locking system (PHILOS), & Group B with percutaneous K-wire xation. Functional outcome was assessed by NEER's Score. Results: Functional outcome at end of 6 months, based on Neer's Score, in group A, came out to be excellent in 12 (80%) and satisfactory in 3 (20%). In group B, excellent in 5 (33.3%) and satisfactory in 10 (66.6%). In Group A, 2 patients developed complications i.e., 1 patient had shoulder stiffness & 1 patient had supercial infection. In Group B, 6 patients developed complications i.e., 4 patients had shoulder stiffness only, 1 patient had supercial infection only and 1 patient had both shoulder stiffness and supercial infection. PHILOS plate provides excellent Conclusion: functional outcome with minimal complications for displaced proximal humerus fractures compared to percutaneous k wire xation

Effectiveness analysis of proximal humerus internal locking system plate combined with rotator cuff reinforcement suture in treatment of Neer type Ⅳ proximal humerus fracture

To investigate the effectiveness of proximal humerus internal locking system (PHILOS) plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture. The clinical data of 48 patients with proximal humeral fractures admitted between January 2016 and December 2020 were retrospectively analyzed, including 18 males and 30 females. The age ranged from 28 to 69 years (mean, 56.3 years). The causes of injury included falling in 39 cases and traffic accident in 9 cases. The time from injury to operation was 2-5 days (mean, 2.8 days). All of them were Neer type Ⅳ proximal humerus fractures, including 11 patients with dislocation. All patients underwent internal fixation with a PHILOS plate after anatomical reduction of the greater nodule, and the rotator cuff was sutured to the plate to reinforce fixation. The operation time was recorded, the wound healing, fracture healing, and complications were observed. The visual analogue scale (VAS) score, Constant-Murley shoulder score, University of California Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function before operation, at 3 months after operation, and at last follow-up. The operation time ranged from 65 to 90 minutes (mean, 76.9 minutes). All incisions healed by first intention. All patients were followed up 9-16 months (mean, 12 months). Fracture reduction was good and all fractures healed, the healing time was 2-6 months (mean, 4.6 months). There was no complication such as subacromial impingement, fracture redisplacement, and screw removal during follow-up. One patient had humeral head necrosis, but the basic function of the shoulder joint was acceptable, the symptoms were mild, and no treatment was performed. At 3 months after operation, the upper limb function of the patients basically recovered. The VAS score, Constant-Murley score, UCLA score, and ASES score significantly improved at 3 months after operation and at last follow-up when compared with preoperative, and further improved at last follow-up than at 3 months after operation ( P<0.05). PHILOS plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture has the advantages of promoting early postoperative rehabilitation exercise, improving postoperative function of shoulder joint, and reducing complications.

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.

COMPARATIVE EVALUATION OF FUNCTIONAL OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION WITH PHILOS AND CLOSED REDUCTION AND PERCUTANEOUS FIXATION WITH K-WIRES IN PROXIMAL HUMERAL FRACTURES

Background: Fracture of the proximal humerus represents the second most common (29.1%) fracture type in the upper extremity after Colle's fracture (37.2%) of the wrist. Signicant controversy continues regarding the best modality for treating displaced proximal humerus fractures. The objective of our study is to comparatively evaluate the functional outcome of ORIF with Proximal Humerus Internal Locking System (PHILOS) and Close Reduction and Percutaneous Fixation with K-wires in proximal humerus fractures. Method: A prospective study was conducted after getting ethical approval at N.S.C.B. Medical College &amp; Hospital, Jabalpur, (M.P.) upon 50 cases admitted with proximal humerus fractures as per inclusion criteria. 25 cases were treated with PHILOS plate in group A and 25 patients were treated with Closed Reduction and Percutaneous Fixation with K-wires in group B. Post op follow up was done at 6 weeks and 12 weeks and functional outcome evaluated by Neer's scoring criteria. Results: Out of 50 cases, excellent scores was obtained in 22 (88%) cases treated with PHILOS in group A, and 18 (72%) cases treated with k-wire xation in group B, satisfactory score was obtained in 3 (12%) in Group A and 6 (24%) in Group B. Conclusion: We obtained excellent results in both groups with each procedure having its own advantage and disadvantages. We found that PHILOS provides secure xation with better functional outcome in terms of range of motion. Fixation with Percutaneous K-wires is also efcient treatment option with intraoperative advantage in terms of invasiveness, blood loss and time taken for surgery with least tissue dissection than PHILOS plating

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra-articular diaphyseal humeral fractures.

The extra-articular distal humerus locking plate (EADHP) is widely used for distal extra-articular diaphyseal humeral fracture fixation. However, it occasionally causes skin prominence and discomfort. The upside-down use of a proximal humerus internal locking system (PHILOS) plate is suggested as an alternative option, but it lacks biomechanical evidence. The purpose of this study was to compare the biomechanical performance between two different fixation methods: themodified use of the PHILOS plate on the anterior cortex versus conventional use of an EADHP on the posterior cortex. Twelve pairs of fresh-frozen cadaveric humeri were used and 7 mm gap osteotomy was performed at 50 mm proximal to the lateral epicondyle to simulate an AO/OTA 12-C1.3 fracture type. Single load to failure was measured after five stiffness tests of the plate-bone constructs in anterior/posterior bending, internal/external torsion, and axial compression. There were no significant differences in metrics between the two groups, except for the load to failure in posterior bending, which was significantly higher for PHILOS (1589.3 ± 234.5) compared to EADHP (1430.1 ± 188.6), p < .023. In conclusion, the modified use of the PHILOS plate showed comparable biomechanical performance compared to the conventional EADHP. The new fixation method offers potential clinical advantages, considering the patient's position and surgical approach at the time of surgery as well as postoperative soft tissue irritation. Therefore, this could be an option for distal humeral extra-articular diaphyseal fracture fixation when the use of EADHP is not suitable or preferred.

Anterior minimally invasive plating osteosynthesis using reversed proximal humeral internal locking system plate for distal humeral shaft fractures.

To describe the surgical application of anterior minimally invasive plating osteosynthesis (MIPO) using reversed proximal humerus internal locking system (PHILOS) plate for multifragmentary distal humeral shaft fractures. Twelve patients with distal humeral shaft fractures (type 12B, n = 6 and type 12C, n = 6) were operated on by anterior MIPO and reversed PHILOS plate fixation. The amount of intact bone in the distal fragment was measured by fracture-to-coronoid distance (FCD). Data of the postoperative alignment, complications, union time, and clinical outcomes were collected. The mean time for fractures to unite in all patients was 14.8weeks (range 12-22). There was no perioperative complication. The mean FCD was 4.8cm (range 2.1-8.1). The mean coronal angulation was 3.4° (range 0-9), and the mean sagittal angulation was 1° (range 0-5). All patients had excellent UCLA shoulder score and MEP score results, and the mean range of elbow motion was 140° (range 130-145). Anterior MIPO using reversed PHILOS plate is safe and effective for multifragmentary fractures of the distal humeral shaft even in a fracture with a length of intact bone above the coronoid fossa of only 2cm.

Results of surgical management of displaced or complex proximal humeral fractures with proximal Humerus internal locking system: A prospective study of 55 cases

Background: The optimal treatment of proximal humeral fractures remains always challenging and controversial. The purpose of this prospective study was to evaluate the functional outcome of proximal humerus internal locking system (PHILOS) plate fixation for displaced or complex proximal humeral fractures and to establish the influencing factors of an unfavourable outcome. Materials and Methods: After obtaining approval from institutional ethics committee, 55 patients with the displaced proximal humeral fractures were managed by open reduction and PHILOS plate fixation through delto-pectoral approach and as per standard protocol. The results of follow-ups were analysed radiologically and clinically, using the “Constant and Murley scoring system” at once in a month for first three months, once in three months for next six months and once in six months thereafter upto 2 years post-operatively. Results: In the present study, out of 55 patients, clinical results were excellent in 50.9%, good in 21.8%, fair in 16.4% and poor in 10.9% patients. Radiological union was achieved in all patients, including two cases of mal-union and one case of delayed union. Post- traumatic frozen shoulder (7 cases), secondary arthritis (5 cases), secondary screw penetration (3 cases), and AVN humeral head (3 cases) were the main complications observed in this study during 2 years of follow-ups, which were treated accordingly. Conclusion: Pre-contoured PHILOS plate preserves shape of humeral head, provides angular stability, facilitates to restore the medial column and prevent secondary varus collapse in severe comminuted and osteoporotic proximal humeral fractures. With proper patient selection, PHILOS plate provides favourable clinical and radiological outcome with acceptable complication rates.

Treatment of proximal humeral fractures with proximal humeral locking system plate via an intertubercular sulcus approach

To observe the effect of proximal humerus internal locking system (PHILOS) plate in the treatment of Neer 2 and 3 part fractures of proximal humerus through tuberosity approach. From July 2015 to January 2018, 15 cases of proximal humerus Neer 2 and 3 fractures were treated with PHILOS plate through intertubercular sulcus approach. There were 7 males and 8 females. The age ranged from 23 to 67 years old, with an average of 46 years old. There were 5 cases on the left side and 10 cases on the right side (including 7 cases of Neer 2 partial fracture and 8 cases of Neer 3 partial fracture). X-ray films and CT were taken before and after operation to assess fracture location and fracture healing. Clinical evaluation included Constant-Murley shoulder function score and operative complications. All 15 patients were treated with the PHILOS. Constant-Murley score was used to evaluate shoulder function after operation. All the 15 cases were followed up, and the duration ranged from 14 to 36 months. All the fractures healed and the healing time ranged from 14 to 26 weeks, averaged 19.1 weeks. There were no complications such as humeral head necrosis, axillary nerve injury and fracture nonunion after operation. At the 3rd month after operation, the shoulder function score of Constant-Murley ranged from 72 to 94 points, with an average of 81 points; 2 cases got an excellent result and 13 good. The PHILOS plate for the treatment of proximal humerus fractures has the advantages of simple operation, small injury and quick recovery of shoulder joint function.

Pre-contouring long helical plate of proximal humerus internal locking system aided by 3D-printing technique in minimally invasive plate osteosynthesis for metadiaphyseal fractures of the proximal humerus: a cadaveric study and clinical experience

Objective To identify the anatomic advantages of pre-contouring long helical plate of proximal humerus internal locking system (PHILOS) aided by 3D-printing technique in minimally invasive plate oseoynthesis (MIPO) for metadiaphyseal fractures of the proximal humerus. Methods Firstly in a cadaveric study, 12 fresh frozen samples of upper extremity were divided into 2 equal groups: 6 in a Synbone group and 6 in a 3D-printing group. Long 10-hole PHILOS plates were pre-contoured helically according to Synbone humerus models in the Synbone group but according to 3D-printing humerus models in the 3D-printing group. All these helical plates were fixed onto the cadaveric humerus using MIPO technique respectively. The horizontal distances between the radial nerve and the lateral side of the plate were measured at the point where the radial nerve penetrates the muscular septum, at the 6th hole on the plate and at the distal end of the plate; the distance between the medial side of the distal plate and the upper arm neurovascular bundle was also measured. Finally, the full lengths of all these cadaveric humeri were measured. Secondly, on the basis of the anatomic study, 16 patients with metadiaphyseal fracture of the proximal humerus were treated at Department of Orthopedic Surgery, The Sixth People’s Hospital of Shanghai from February 2013 to March 2016, using the same MIPO technique and the same long 10-hole PHILOS plates pre-contoured helically on the 3D printing models which were mirrored on the humerus on the healthy side of the patients. They were 4 men and 12 women, aged from 59 to 87 years (mean, 71.0 years). By the AO/OTA classification, 10 cases were type B and 6 type C. The fracture line involved the proximal humerus in 7 cases. Postoperative complications were followed up. At the final follow-up, the shoulder function was assessed according to the Constant-Murley score and the elbow function according to the Mayo Elbow Performance Score (MEPS). Results By the anatomic measurement, the full length of cadaveric humerus averaged 30.17±1.93 cm in the Synbone group and 29.75±2.17cm in the 3D-printing group, showing no significant difference (P>0.05). The horizontal distances between the radial nerve and lateral side of the plate at the point where the radial nerve penetrates the muscular septum, at the 6th hole on the plate and at the distal end of the plate in the Synbone and 3D-printing groups were, respectively, 11.50±0.92 mm versus 17.87±1.88 mm, 6.90±1.78 mm versus 14.83±1.50 mm, and 5.14±1.14 mm versus 8.36±1.27 mm, all showing significant differences between the 2 groups (P 0.05). The clinical observation found no iatrogenic nerve injury. The 16 patients were followed up for an average of 25.3 months (range, from 24 to 38 months). All fractures got united uneventfully. At the final follow-up, their Constant-Murley scores averaged 77.6 points and their MEPS 96.5 points. Conclusion The risk of iatrogenic injury to the radial nerve can be lowered when 3D-print technique is applied for helical pre-contouring of long PHILOS plate in the MIPO for metadiaphyseal proximal humeral fractures, leading to satisfactory clinical results. Key words: Humeral fractures; Fracture fixation, internal; Anatomy; Clinical trial; 3D printing technology

Results and analytical outcomes of proximal humerus plating in adults with proximal humerus fracture

Fracture of proximal humerus is the second most common fracture of the upper extremity, following distal forearm fractures. Aim of the present study was to evaluate the efficacy of proximal humerus internal locking system (PHILOS) plate fixation for proximal humerus fractures. Functional outcomes of 12 men and 18 women aged 22 to 78 (mean, 58) years who underwent PHILOS plate fixation for proximal humeral fractures were reviewed. Indications for surgery were 2 part (n=9), 3 part (n=14) or 4-part (n=7) closed proximal humeral fractures with angulation of more than 45 degrees or displacement of more than 1 cm. Functional outcomes and shoulder range of movement were assessed based on the Constant scoring system. All patients will be followed up at monthly intervals for 6 months. During this period patient, will be motivated for physiotherapy and gradual normal use of the affected limb. Fracture union will be assessed clinically and radiologically. In our study of fracture proximal humerus union in most of the cases (24) occurring between 10- 14 weeks. Range of union time was 8 to 18 weeks. one case of avascular necrosis of head occur in our case. In out of 30 cases excellent result in 7 cases, Good in16 cases Satisfactory in 5 cases and Poor in 2 cases were obtained. The PHILOS plate fixation is effective treatment for proximal humeral fractures particularly in osteoporotic bones.

Assessment of Screw Length of Proximal Humerus Internal Locking System (PHILOS) Plate for Proximal Humeral Fractures Using Three-Dimensional Computed Tomography Scan

BackgroundScrew perforation and varus collapse are common complications of treatment with a PHILOS (proximal humerus internal locking system) plate for proximal humerus fractures, which are associated with improper screw length selection and lack of medial column support. The purposes of this study were: (1) to measure the proper length of periarticular screws of the PHILOS plate in the humeral head, and (2) to determine what factors influence the screw length and implantation of the inferomedial support screw.Material/MethodsComputed tomography (CT) images of the normal proximal humerus in 134 cases were retrospectively reviewed. The length of periarticular screws was measured using three-dimensional (3D) techniques. Intraobserver and interobserver reliability of measurement were evaluated using intraclass correlation coefficients (ICCs). Sex and body height influences on screw length and implantation of the inferomedial screw were analyzed.ResultsAll measurements had excellent agreement (ICC>0.75). The screw length and implantation rate of the inferomedial screw were greater in males than in females. Positive correlations were observed between body height and screw length and implantation of the inferomedial screw (all P<0.001).ConclusionsThe screws were longer and the implantation rate was higher for inferomedial screws in males than in females, and were positively correlated with body height. Our data can be used as a reference for surgeons to reduce the number of times screws are changed intraoperatively and to reduce operation duration and minimize use of intraoperative fluoroscopy for proximal humerus fractures treated with the PHILOS plate.

PHILOS plate in Proximal Humerus Fracture – its functional outcome and complications

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

Philos Plate in Proximal Humerus Fracture–Its Functional Outcome and Complications

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

Early Results of Three and Four Part Proximal Humerus Fractures Treated with PHILOS (Proximal Humerus Interlocking System) Plate

Achieving stable fixation has been a challenge in proximal humerus fractures. PHILOS (Proximal Humerus internal locking system) is the latest generation of locking compression plate system for such fractures. The aim of the current study was to assess the clinical and functional outcome of proximal humeral fractures (3-part and 4-part) treated with the PHILOS plate. This was a retrospective review of first ten cases operated at our centre by a single surgeon. The patients were followed in out-patient clinics till fracture union. Fracture healing was assessed by clinical and radiological criteria, and shoulder function was evaluated using Constant and Murley score. Average follow-up was 23±3 weeks. Eight (80%) patients had fracture healing at an average of 11.6±0.8 weeks post-operatively, and gained moderate range of motion. Two (20%) patients had complications, i.e. one had deep infection and another had screw pull-out. Conclusion: Open reduction and internal fixation with PHILOS plate showed acceptable functional outcome. Apart from the one case with screw-pull-out, our early results using this plate are encouraging, with no other implant-related complications and good early healing.

PHILOS Plate: Is it the Panacea for all Proximal Humerus Fractures?

The problem of fixation of 3 and 4 part displaced proximal humerus fractures was thought to be greatly solved with the evolution of proximal humerus internal locking system (PHILOS). We report a case of migration of screws of PHILOS plate into the shoulder joint, where salvage was done with hemi-arthroplasty. The decision for osteosynthesis in complex 3 and 4 part fracture needs a high index of awareness of the potential complications of PHILOS.