Treatment Of Proximal Humerus Fractures Research Articles

In-hospital Complications Are More Likely to Occur After Reverse Shoulder Arthroplasty Than After Locked Plating for Proximal Humeral Fractures.

Currently, there seems to be a paradigm change in the surgical treatment of proximal humeral fractures in patients aged 65 years and older, with a considerable increase in the use of reverse total shoulder arthroplasty (RTSA) compared with angular stable internal fixation (locking plate fixation). However, even among shoulder specialists there is controversy regarding the best treatment strategy. To evaluate for (1) a greater risk of in-hospital major adverse events, (2) a greater risk for in-hospital surgical complications, and (3) a greater risk of 30-day mortality, locking plate fixation and RTSA were compared for the treatment of proximal humerus fractures of patients aged 65 years and older after controlling for potentially confounding variables in a large-database analysis. Health claims data of the largest German insurance company including approximately one-third of the population (26.5 million policyholders) between 2010 and 2018 were analyzed. This database was chosen because of its size, nationwide distribution, and high quality/completeness. In total, 55,070 patients (≥ 65 years of age) treated with locking plate fixation (75% [41,216]) or RTSA (25% [13,854]) for proximal humeral fracture were compared. As primary endpoints, major adverse events (including acute myocardial infarction, stroke, organ failure, resuscitation, and death) and surgical complications (infection, hematoma, loss of reduction, dislocation, and revision surgery) were analyzed. The risk of all endpoints was analyzed with multivariable logistic regression models in the context of comorbidities to address existing group differences. After controlling for potentially confounding variables such as age, sex, and risk profile, RTSA was associated with a higher risk for major adverse events (OR 1.40 [95% CI 1.29 to 1.53]; p < 0.001) and surgical complications (OR 1.13 [95% CI 1.05 to 1.21]; p < 0.01) compared with locking plate fixation. There was no evidence for an increase in mortality (OR 0.98 [95% CI 0.86 to 1.12]; p = 0.81). The increased in-hospital risk for major adverse events and surgical complications may moderate the enthusiasm associated with RTSA for proximal humeral fractures in patients 65 years and older. Treatment decisions should be based on individual risk estimation to avoid potential harmful events. Future studies must include long-term outcomes and quality of life to enlighten these findings in a broader context. Level III, therapeutic study.

Surgical treatment of proximal humerus fractures with intramedullary nail

Introduction. Proximal humerus fracture is the most common fracture of the shoulder gir- dle, accounting for approximately 4-7% of all fractures. The aim of this study is to provide surgeons safe and effective surgical solutions, minimizing the risk of complications.Materials and methods. We retrospectively analyzed all 3-fragment proximal humerus frac- tures, treated between January 2017 and December 2018 with the Diphos® short intramedullary nail (Lima Corporate®, San Daniele del Friuli, Italy). 33 patients, 19 men (57.6%) and 14 women (42.4%), were included; average age was 68.4 years (min. 63 - max. 78, SD 3.67).Results. Hospitalization was 6.27 ± 2.87 days (3.6 days before undergo surgery, 2.7 days after). Mean surgical time was 27.36 ± 8.49 minutes. On average, patients healed after 78.36 days. We registered 10 complications: 4 malunion (12.1%), 2 screw-cut outs (6.1%), 1 delayedunion (3.0%), 1 cuff lesion (3.0%), 1 loss of reduction (3.0%), and 1 intraoperative fracture(3.0%). Overall re-operation rate was 6.1%.Conclusions. During surgery, it is crucial to choose the right entry point when placing the nail. Failing at this level can lead to intraoperative and postoperative complications, in addi- tion to worse clinical outcomes.

Current trends in the management of proximal humerus fractures in elderly patients

Proximal humeral fractures are among the most common fractures in the elderly. Along with the increasing life expectancy of the Western population, the incidence of these fractures is rising rapidly, with osteoporosis as an important factor, affecting mostly active persons aged 60 and older. In such patients, proximal humeral fracture can potentially affect independ- ence and deteriorate the quality of life.Currently, several options are available for the treatment of proximal humerus fractures in elderly patients. The main treatments include open reduction and internal fixation, percutaneous closed fixation, and intramedullary nailing or total shoulder arthroplasty, depending on multiple variables including patient age, comorbidities, activity level, functional demands, and goals/expectations of treatment.

Study of functional outcome following proximal humeral internal locking system plating for displaced proximal humeral fractures

Proximal humerus fractures accounts for about 4 to 5% of all fractures. They are the third most common fractures in elderly population after hip and distal radius fractures. Regarding treatment of proximal humerus fractures, controversies still exists whether to do conservative or operative management. Various operative procedures are carried out, recent trend in internal fixation has moved on to locking plates. The present study is undertaken to evaluate the functional outcome and complication of proximal humerus fractures treated by philos locking plate. This is a prospective study involving adults (>18yrs) with proximal humerus fractures admitted to AJ Institute of medical sciences and research centre, Mangalore. In this study period 30 cases of fractures of proximal humerus were treated by open reduction and internal fixation with Philos locking plate were evaluated. In our series, majority of the patients were males with road traffic accident being the commonest mode of injury involving 2 part, 3 part and 4 part fractures of proximal humerus and fracture dislocations. The fractures united in all 30 patients. Among the 30 patients 2(6.7%) patients had an excellent outcome, 10(33.3%) patients had a good outcome, 13(43.3%) patients had a fair outcome, and 5(16.7%) patients had a poor outcome according to constant and murley scoring system. In conclusion Philos locking plate is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization.

Concept of neutral rotation sling for non-operative treatment of proximal humerus fractures

Concept of neutral rotation sling for non-operative treatment of proximal humerus fractures

Outcomes of acute but not delayed reverse total shoulder arthroplasty for proximal humerus fracture are equal to those for rotator cuff arthropathy

BackgroundThe utilization of reverse total shoulder arthroplasty (RTSA) for the treatment of proximal humerus fractures in the elderly is increasing. Recent results support the use of RTSA for this indication over hemiarthroplasty or open reduction internal fixation (ORIF). However, there are limited data on the outcomes of RTSA for fracture or fracture sequelae as compared to RTSA for cuff tear arthropathy (CTA). We hypothesized that patients undergoing RTSA for fracture or fracture sequelae would have worse outcomes compared to patients undergoing RTSA for CTA. MethodsThis was a retrospective analysis of a prospectively collected outcomes database of all patients undergoing shoulder arthroplasty at a single institution between 2008 and 2019. Patients were included if they underwent primary RTSA for a diagnosis of acute fracture, fracture nonunion or malunion, failed hemiarthroplasty or ORIF for proximal humerus fracture, or rotator cuff arthropathy. The primary outcome was American Shoulder and Elbow Surgeons (ASES) score at the most recent follow-up, with minimum 1-year follow-up. Secondary outcomes included range of motion (ROM) at most recent follow-up, patient satisfaction with surgery, and revision or reoperation rates. Analysis of variance was used to compare continuous variables between the groups, while chi-square or Fisher's exact test were used to compare categorical variables. Linear regression analysis was used to perform multivariable analysis. Prosthesis survival rates were calculated using Kaplan-Meier survival analysis. Significance was defined as P< .05. ResultsThere were 287 patients included in the final cohort, including 62 with fracture and 225 with CTA. Sex, diagnosis, increasing patient comorbidities, and diagnosis (malunion/nonunion and failed prior surgery) were associated with worse ASES scores on univariate analysis (P < .05). On multivariate analysis, there was no difference in outcomes (ASES and ROM) between the acute fracture and CTA cohorts (P > .05). Outcomes of delayed RTSA for malunion/nonunion and hemiarthroplasty/ORIF were significantly worse than those for acute fracture/CTA (P < .01). Three-year prosthesis survival was 95% for CTA, 97% for acute fracture, 97% for malunion/nonunion, and 78% for failed prior surgery. ConclusionTreatment of acute proximal humerus fractures with RTSA leads to similar improvements in patient outcomes compared to elective treatment for CTA, but outcomes of delayed RTSA for fracture are considerably worse. These findings provide further guidance to clinicians counselling patients on treatment options and outcomes for proximal humerus fractures. Level of evidenceLevel III; Retrospective comparative study

Experimental and numerical investigation of secondary screw perforation in the human proximal humerus

Surgical treatment of proximal humerus fractures remains challenging, with a reported failure rate ranging from 15% to 35%. The dominant failure mode is secondary, i.e. post-operative screw perforation through the glenohumeral joint. A better understanding and the ability to predict this complication could lead to improved fracture fixation and decreased failure rate. The aims of this study were (1) to develop an experimental model for single screw perforation in the human humeral head and (2) to evaluate the ability of densitometric measures and micro finite element (microFE) analyses to predict the experimental failure event.Screw perforation was investigated experimentally in twenty cuboidal specimens cut from four pairs of fresh-frozen human cadaveric proximal humeral heads. A centrally inserted 3.5 mm screw was pushed quasi-statically at a constant displacement rate until perforation of the articular cartilage in each specimen. Force and displacement were recorded and evaluated at both initial screw loosening and perforation events. Bone volume was calculated around and in front of the screw and tip-to-joint distance was measured on the combined pre- and post-instrumentation micro computed tomography (microCT) scans. Implicit linear and explicit non-linear microFE models were created based on the microCT scans. The strength of these densitometric, geometrical and microFE methods to predict the experimental results was evaluated via correlation analysis. The bone volume measures were optimized in a parametric analysis to maximize correlation coefficients.The strongest and quantitatively correct predictions of perforation force (R2 = 0.93) and displacement (R2 = 0.77) were achieved using the explicit, non-linear microFE models. Linear microFE simulations provided the strongest predictions of loosening force (R2 = 0.90). Correlation strengths reached by optimized bone volume measures for predicting experimental force and by tip-to-joint distance for predicting displacement were only slightly inferior compared to the results of microFE models.The strong correlations achieved with densitometric and geometric measures indicate that monotonic perforation of single screws through the articular surface of the humeral head can be well predicted with these easily accessible measures. However, non-linear microFE models delivered even stronger correlations and quantitatively correct predictions of perforation force and displacement. This indicates that if computational resources are available, non-linear simulations may have a high potential to investigate more complex fixations and loading scenarios.

A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

Background and hypothesisThe typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column.Materials and methodsWe performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively.ResultsThere was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred.ConclusionsThe combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

Predicting reoperation after operative treatment of proximal humerus fractures.

The current understanding of the factors associated with a second surgery or loss of alignment after operative treatment of a proximal humerus fracture has relied on small sample studies with stepwise regression analysis. In this study, we used a powerful regression analysis over a large sample and with many variables to test the null hypothesis that there are no factors associated with a revision surgery or loss of alignment after operative treatment of proximal humerus fractures. A retrospective review of all surgically treated proximal humerus fractures from January 1, 2000, to December 31, 2015, was performed at a tertiary level hospital. We extracted longitudinal medical records for all patients, and the data were organized into two categories of predictors: fracture/operative characteristics and patient characteristics. During the study period, 423 patients met the inclusion criteria. Three hundred and fourteen of the fractures underwent Open Reduction Internal Fixation (ORIF) and 109 underwent Hemiarthroplasty. Thirty-three patients underwent revision surgery (8%). Seventy-nine patients treated with ORIF had loss of alignment (25%). Across the entire cohort, the least absolute shrinkage selection operator (LASSO) analysis found that patients between 40 and 60years of age had a higher odds of revision surgery (OR = 1.6). In patients treated with ORIF, the LASSO regression found an unreduced calcar to be the strongest predictor of loss of alignment (OR = 5.5), followed by osteoporosis (OR = 1.3), prior radiation treatment (OR = 1.3), unreduced greater tuberosity (OR = 1.2) and age over 80years (OR = 1.2). Reoperation after proximal humerus surgery is infrequent even though loss of alignment is common. In our cohort, not all patients who had a loss of alignment underwent revision surgery; consequently, obtaining the best possible reduction at the index surgery is paramount.

Does plate-screw density affect the functional outcomes in the treatment of proximal humerus fractures?

The aim of the study is to evaluate the relationship between plate-screw density (PSD), functional results, and complication rates in the treatment of proximal humerus fractures (PHFs) with proximal humerus locking anatomical plate (PHLAP). Consecutive 43 patients (22 females and 21 males) who underwent PHLAP for the treatment of PHF between 2010 and 2016 were evaluated. AO classifications were used for the classification of fractures. Based on the biomechanical stability the-ory of Erhardt et al., the patients were divided into two groups as <60% and >60% according to the number of screws fixed to the humeral head for the determination of PSD. The patients were divided into two groups as PSD <60% (n=21) and PSD>60% (n=22) according to the number of screws fixed to the humeral head for the determination of PSD. Functional results were evaluated using the Constant-Murley shoulder score (CMS). Radiological evaluation was performed with collodiaphyseal angle (CDA), varus-valgus angulation, avascular necrosis (AVN), and arthrosis. The groups were compared in terms of demographic characteristics, functional results, radiological scores, and complications. The mean age was 54.47±17.43 years and the mean follow-up time was 19.51±5.27 months. Although the CMS scores of patients with a PSD of over 60% were higher than those below 60%, the CMS score did not differ statistically. In groups, the mean CDA of the operated shoulder was significantly lower than that of the non-injured side (p=0.002). Eight patients had varus angulation, whereas two patients had humerus head AVN. No significant relationship was observed between PDS and functional scores, radiolog-ical results, and complications. Functional results of PSD >60% are higher than PSD <60% group but there is no statistical difference between groups according to functional, radiological results, and complications.

Functional outcome of different treatment modalities of proximal humerus fracture (3 part and 4 part)

Introduction: Proximal humerus fracture is the most common fracture of humerus consisting 45% of all humerus fracture and second most common fracture in upper extremity. Diagnosis and proper management of proximal humerus fracture is important as the shoulder joint needs a high demanding function for daily activities. Various treatment options available for proximal humerus fracture from conservative management, K wire fixation, ORIF and plating, hemiarthroplasty to Reverse Shoulder arthroplasty.Aims and Objective: Our study aimed to evaluate the one year follow up results of different treatment modalities in a perspective series of proximal humerus fracture and study complication, if any involved with these modalities and to find out the basis of selecting the mode of treatment of proximal humerus fracture to bring out the best functional outcome.Materials and Method: 40 patients with displaced proximal humerus fracture (3 part and 4 part) treated between September 2018 to August 2019 were included in this study. Out of 40 patients in our study 32 patients have 3 part and 8 patients have 4 part fracture. 33 patients (3 part-27, 4 part-6) treated with PHILOS plating. 3 patients (All 3 part) treated with K wire fixation. 2 patients (All 3 part) treated conservatively. 2 patients (All 4 part) treated by Reverse Shoulder Arthroplasty. The functional outcome has been assessed by Constant-Murley shoulder scoring system.Results: Out of 40 cases 10(25%) patients had excellent result, 21(52.5%) good, 8(20%) moderate and 1 (2.5%) patient show poor outcome. There are few complications in our study-Malunion (3 patients), nonunion (2 patients), Joint stiffness (1 patient), Instability (1 patient), Heterotropic Ossification (1 patient), AVN of humeral head (2 patients).Conclusion: From this study we found that PHILOS is an effective treatment for 3 part fracture and for 4 part fracture Reverse Shoulder Arthroplasty is appears to be better option.

Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

ObjectiveTo investigate the inter-rater reliability of Barbary macaques compared with an expert group of surgeons for the choice of treatment and predicted outcome of proximal humerus fractures.DesignUncontrolled, blinded, comparative behavioural...

ESTIMATION OF THE OPTIMAL FIBULAR GRAFT ANGLE FOR PROXIMAL HUMERUS FRACTURES USING FINITE ELEMENT ANALYSIS

Proximal humerus fracture is a common injury and is usually treated using an internal fixation. However, clinical studies have reported that such treatments are associated with problems such as varus deformity and screw penetration. Therefore, to solve these problems, a surgical method using fibular allografts (FAs) is recently reported. Thus, this study is aimed to confirm the effective insertion angle ([Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text]) of the FA. We applied axial and shear loads to finite element models used in our study. Finite element simulations using these models were repeated five times for each fibular insertion angle. We evaluated the construct stiffness, stress distribution on the plate and fibula, and fracture micromotion. Results showed that the method using the FA caused less stress on the plate and provided higher structural stability than the method without using the FA. In particular, the axis perpendicular condition yielded significantly greater construct stiffness and caused less von Mises stresses than the other conditions. In conclusion, the finite element analysis results showed that the FA inserted horizontally was effective in the treatment of proximal humerus fracture with an unstable medial support.

Treatment of unusual locked posterior fracture-dislocation of the shoulder: a case series.

Background Locked posterior fracture-dislocation of the shoulder (LPFDS) is a very rare injury that occurs predominantly in young patients following high-energy trauma. The long-term outcome of the treatment of this injury is often poor. This study sought to present the characteristics of injury, discuss the pathological anatomy, and to report the treatment outcomes of our case series. Methods Between January 2012 and May 2018, a total of 234 patients who underwent surgical treatment for proximal humerus fractures were reviewed. Among them, six patients (mean age, 54.7 years; range, 35–76 years) with LPFDS were included in this study. Four patients were treated with open reduction and internal fixation (ORIF) with locking plates, one with hemiarthroplasty, and one with reverse total shoulder arthroplasty. Clinical results were evaluated by Constant, American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) scores and radiologic evaluation was conducted using follow-up radiographs. Results The mean length of follow-up was 26.2 months (range, 12–54). The mean Constant, ASES, and VAS scores were 66.7, 65.5, and 2.2, respectively. Four patients who underwent ORIF achieved bony union, but avascular necrosis (AVN) of the humeral head was observed in two patients. No complications were observed in the patients who underwent arthroplasty surgery until final follow-up. ConclusionsIn the treatment of LPFDS, replacement arthroplasty can produce predictable results. The approach of ORIF may be considered as a first choice of treatment in young patients but is sometimes correlated with postoperative complications such as AVN and the functional outcomes may be unpredictable. Therefore, patients should undergo careful diagnosis and treatment of this type of injury.

The financial burden of reverse shoulder arthroplasty for proximal humerus fractures.

AimsThe purpose of this study was to evaluate the cost of reverse shoulder arthroplasty (RSA) for patients with a proximal humerus fracture, using time-driven activity based costing (TDABC), and to compare treatment costs with reimbursement under the Healthcare Resource Groups (HRGs).MethodsTDABC analysis based on the principles outlined by Kaplan and a clinical pathway that has previously been validated for this institution was used. Staffing cost, consumables, implants, and overheads were updated to reflect 2019/2020 costs. This was compared with the HRG reimbursements.ResultsThe mean cost of a RSA is £7,007.46 (£6,130.67 to £8,824.67). Implants and staffing costs were the primary cost drivers, with implants (£2,824.80) making up 40% of the costs. Staffing costs made up £1,367.78 (19%) of overall costs. The total tariff, accounting for market force factors and high comorbidities, reimburses £4,629. If maximum cost and minimum reimbursement is applied the losses to the trust are £4,828.67.ConclusionRSA may be an effective and appropriate surgical option in the treatment of proximal humerus fractures; however, a cost analysis at our centre has demonstrated the financial burden of this surgery. Given its increasing use in trauma, there is a need to work towards generating an HRG that adequately reimburses providers.Cite this article: Bone Jt Open 2020;1-12:731–736.

Dynamic locking screws in proximal humeral plate osteosynthesis demonstrate superior fixation properties: a biomechanical study

PurposeAngular stable implants reduced the complication rate in the treatment of humeral head fractures. But the failure rate is still high. To further reduce the risk of cut-out, cement augmentation of screws was introduced. A reason for failure of plate osteosynthesis might be the extremely high stiffness of the screw-plate interface leading to a loss of reduction and cut-out of screws. A more homogeneous distribution of the forces on all screws may avoid secondary dislocation. We hypothesize that dynamic osteosynthesis minimizes screw loosening and results in a higher load to failure than standard locking screws.MethodsTwelve paired human humerus specimens were analysed. A standardized three-part fracture model with a metaphyseal defect was simulated. Within each pair of humeri, one was fixed with a Philos plate and standard locking screws (LS), whereas the other humerus was fixed with a Philos plate and dynamic locking screws (DLS). A cyclic varus-bending test or a rotation test with increasing loading force was performed until failure of the screw-bone-fixation.ResultsIn the varus bending test, pairs failed by screw loosening in the humeral head. The LS-group reached 2901 (601–5201) load cycles until failure, while the DLS-group failed after 3731 (2001–5601) cycles. This corresponds to a median loading of 195 N for the LS-group and 235 N for the DLS-group (p = 0.028). In the rotation test the LS-group reached a median of 1101 (501–1501) load cycles until failure of fixation occurred, while the DLS-group failed after 1401 (401–2201) cycles (p = 0.225).ConclusionsPlate fixation using dynamic locking screws for the treatment of proximal humerus fractures demonstrated more load cycles until failure compared to standard locking plate osteosynthesis.

A study of functional and radiological outcome of complex fracutre dislocation of proximal humerus treated with proximal humeral internal locking system (Philos) plate

Fracture dislocations of the proximal humerus are extremely rare and have poor functional and radiological outcome regardless of many available surgical interventions. There has been a wide variation in optimum modality of treatment of proximal humerus fractures ranging from conservative treatment, open reduction and internal fixation to total and reverse shoulder arthroplasty. We have evaluated the outcome of efficacy of proximal humeral internal locking system (PHILOS) plate in complex fracture dislocation of the proximal humerus. A total of 20 patients with fracture dislocation of proximal humerus were included in the study after careful inclusion and exclusion criteria. All fracture dislocations were fixed with proximal humeral internal locking system (PHILOS) plate and patients were followed up at regular intervals. Final evaluation was done based on Neer's scoring system. Open reduction and internal fixation of proximal humeral fracture dislocation with the PHILOS plate was associated with good functional and radiological outcomes provided the correct surgical technique was used.

Assessment of the functional outcome of proximal humerus fracture following “PHILOS” plating

Objective: The aim of our study was to evaluate the functional outcome using Constant-Murley scoring and grading system and complications of proximal humeral fractures in the elderly Indian population treated with proximal humerus internal locking system (PHILOS). Method: A prospective study was carried out in a tertiary care center in Kolhapur. A total number of 46 patients with fracture of proximal humerus (NEERs 2 part, 3part & 4part) were studied between January 2019 and Oct 2020. All were treated with PHILOS via deltopectoral approach. A mean follow up of 12 months was carried out, and evaluation was done with the help of Constant-Murley scoring and grading system. Result: The mean radiological union time was 16 weeks. The outcome was measured using Constant-Murley scoring and grading system. Average follow up period was 12 months with good patient satisfaction. Total of 11 patients out of 46 reported complications like Malunion (4.50%), Shoulder Joint Stiffness (17.80%), Infection (8.90%) and Implant Loosening (2.20%). No case of peripheral neuropathies reported in any of the patients. Conclusion: PHILOS plating via deltopectoral approach is a good treatment option showing good clinical outcome in the treatment of proximal humerus fracture (NEERs 2/3/4 part). It offers a more stable fixation and deltopectoral approach gives better exposure for the surgery.

Functional outcome of proximal humerus fracture treated conservatively Vs PHILOS plate

Aim and Objective: Fracture of the proximal humerus, part 2, 3 and 4 have been a challenge to achieve stable fixation .The goal is to achieve near anatomical reduction, preserve biology, stabilization and achieve early mobilization. PHILOS plate provide rigid fixation, more angular stability and good union rate. In this study we have assessed the functional outcome of patients who have undergone PHILOS plating for proximal humerus fracture vs the patient treated conservatively. Material and method: Study was conducted in department of orthopaedics, Rajah Muthiah Medical College and Hospital. Total of 20 patient with fracture of proximal humerus was observed with 10 patient treated using PHILOS plate and 10 patient treated conservatively. Open reduction and internal fixation was performed in 10 patients and in 10 patient u-slab was applied. Result were assessed by constant and murley shoulder outcome score Result: The average follow up time was 6 months. Results were analysed in respect to union of fracture, range of motion of shoulder joint. The mean union time was 8 weeks. Conclusion: PHILOS plating is effective in treatment of proximal humerus fracture with high rate of bony union and early mobilization with excellent clinical and radiological outcome.

Functional outcome of proximal humerus fracture using PHILOS plating

Aim and Objective: Fracture of the proximal humerus, part 2, 3 and 4 have been a challenge to achieve stable fixation .The goal is to achieve near anatomical reduction, preserve biology, stabilization and achieve early mobilization. PHILOS plate provide rigid fixation, more angular stability and good union rate. In this study we have assessed the functional outcome of patients who have undergone PHILOS plating for proximal humerus fracture.Material and Method: Study was conducted in department of orthopaedics, Rajah Muthiah Medical College and Hospital. Total of 20 patient with fracture of proximal humerus treated using PHILOS plate. Open reduction and internal fixation was performed in 20 patients. Result were assessed by constant and murley shoulder outcome score Result: The average follow up time was 6 months. Results were analysed in respect to union of fracture, range of motion of shoulder joint. The mean union time was 8 weeks. Conclusion: PHILOS plating is effective in treatment of proximal humerus fracture with high rate of bony union and early mobilization with excellent clinical and radiological outcome.