FUNCTIONAL OUTCOME OF PROXIMAL HUMERAL FRACTURES TREATED WITH PHILOS PLATE IN ADULTS

Authors

  • Akram Muhammad Aliuddin Department of Orthopaedics, Liaquat National Hospital, Karachi
  • Zaki Idrees Department of Orthopaedics, Liaquat National Hospital, Karachi
  • Mehroze Zamir Department of Orthopaedics, Liaquat National Hospital, Karachi
  • Muhammad Kazim Rahim Najjad Department of Orthopaedics, Liaquat National Hospital, Karachi
  • Syed Amir Ali Shah Department of Orthopaedics, Liaquat National Hospital, Karachi

Abstract

Background: Proximal humeral fractures account for 4–5% of all fractures. Most fractures are minimally displaced and can be managed non-operatively in adults. Displaced and unstable fractures are difficult to manage and should be treated to achieve painless shoulder and full function. Our aim was to evaluate the functional outcome of proximal humerus fractures (Neers classification 2 part, 3 part and 4 part) treated with PHILOS (Proximal humeral internal locking system). Methods: We retrospectively reviewed 22 patients who had proximal humerus fractures treated with PHILOS plate from Jan 2012 to June 2013 conducted at Orthopaedic Department Liaquat National Hospital. Clinical outcome was measured using DASH (disability of arm, shoulder and hand) Score System. Radiological union was assessed by serial X rays. Result. Two patients were lost to follow up. Mean age was 40 years (20–70). Mean follow up was 6 months. 4 patients had two-part fracture, 10 patients had three-part and 6 patients had four-part fracture. Radiological union was achieved in average 8.31 weeks (±1.37SD). Average DASH score in young patients was 15.14 (±1.91SD) and in elderly was 31.66 (±4.08SD). One case of implant failure was noted. Better results in younger patients were achieved as compared to elderly proved by DASH score. Conclusion: Increase in number of fracture parts and delay in treatment did not affect the outcome. Our study concluded that this implant provides stable fixation in younger patients with good quality bone sufficient to allow mobilization.Keywords: Proximal Humeral Fractures, PHILOS, DASH, functional outcome, adults, humerus, adults

References

Court-Brown CM, Garg M, McQueen M. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001;72(4):365–71.

Shahid R, Mushtaq A, Northover J, Maqsood M. Outcome of proximal humerus fractutre treated by PHILOS plate internal fixation. Experience of a District General Hospital. Acta Orthop Belg 2008;74(5):602–8.

Strohm PC, Helwig P, Konrad G, Sudkamp NP. Locking plates in proximal humerus fractures. Acta Chir Orthop Traumatol Cech 2007;74(6):410–15.

Ollson C, Nordquist A, Petersson CJ. Long term outcome of proximal humerus fracture predicted after 1 year: a 13 year prospective population- based follow up study of 47 patients. Acta Orthop 2005;76(3):397–402.

Nho SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD. Innovations in the management of displaced proximal humerus fractures. J Am Acad Orthop Surg 2007;15(1):12–26.

Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, et al. Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimen. Arch Orthop Trauma Surg 2003;123(2-3):74–81.

Park MC, Murthi AM, Roth NS, Blaine TA, Levine WN, Bigliani LU. Two part and three part fractures of the proximal humerustreated with suture fixation. J Orthop Trauma 2003;17(5):319–25.

Hall MC, Rosser M. The structure of upper end of humerus with reference to osteoporotic changes leading to fractures. Can Med Assoc J 1963;88(6):290–94.

Chudik SC, Weinhold P, Dahners LE. Fixed-angle plate fixation in simulated fractures of proximal humerus: a biomechanical study of a new device. J Shoulder Elbow Surg 2003;12(6):578–88.

Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and Evaluation. J Bone Joint Surg 1970;52(6):1077–89.

Sadowski C, Riand N, Stern R, Hoffmeyer P. Fixation of fractures of proximal humerus with PlanTan humerus fixator plate: early experience with a new implant. J Shoulder Elbow Surg 2003;12(2):148–51.

Wanner GA, Wanner-Schmid E, Romero J, Hersche O, von Smekal A, TrentzO, et al. Internal fixation of displaced proximal humeral fractures with two one third tubular plates. J Trauma 2003;54(3):536–44.

Zyto K, Ahrengart L, Sperber A, Tornkvist H. Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Am 1997;79:412–7.

Atalar AC, Demishan M, Uysal M, Seyahi A. Treatment of Neer type 4 impacted valgus fractures of proximal humerus with open reduction, elevation and grafting. Acta Orthop Traumatol Turc 2007;41(2):113–19.

Pleko M, Kraus A. Internal fixation of proximal humeral fractures using the proximal humeral fractures using the locking proximal humeral plates. Oper Orthop Traumatol 2005;17(1):25–50.

Bjorkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand 2004;75(6):741–5.

Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 2007;21(3):185–91

Downloads

Published

2016-06-01