Functional And Radiological Outcome Of Proximal Humerus Fracture Treated With Proximal Humerus Internal Locking System (Philos) Plating

Abstract

Background: The proximal humerus fracture is a very common upper limb fracture which seriously impacts the shoulder function and predominantly occurs in elderly people with osteoporosis. Treatment of displaced fractures and fractures with movement is difficult, because of the complex anatomy and the possibility of complications after treatment. While the Proximal Humerus Internal Locking System (PHILOS) plating is a method that affords stable fixation and early rehabilitation, functional and radiological outcomes should be monitored on an ongoing basis. Objective: The purpose of this study was to evaluate the functional and radiological results of proximal humerus fractures fixed with proximal humeral interlocking screw (PHILOS) and to analyses the complications following this fixation technique. Methods: A prospective observational study of 281 patients with proximal humerus fracture was performed who underwent open reduction and internal fixation with PHILOS plates. Functional outcomes were assessed for 6 months using the Constant-Murley Score, and radiological outcomes were assessed using follow-up radiographs for fracture union, alignment and implant stability. Results: The Mean Constant-Murley Score at 6 months was 78.6 ± 12.5 with 72.9% being excellent or good in terms of function. In 91.5% of cases complete fracture union was seen. The total complication rate was 12.4%, comprising of shoulder stiffness (4.6%), screw penetration (3.2%), infection (2.1%), failure of fixation (1.8%) and avascular necrosis (0.7%).  Conclusion: PHILOS plating is effective in fixing proximal humerus fractures and has good functional & radiological results. Correct reduction, proper positioning of the implant and planned rehabilitation are the key to optimal healing and minimum complications.

Keywords: Proximal humerus fracture; PHILOS plating; Locking plate; Constant-Murley Score; Radiological outcome; Shoulder function