Functional and Radiological Outcome of Proximal Humerus Fractures Treated with PHILOS Plate

INTRODUCTION: Fractures of proximal humerus account for about 4 to 5% of all fractures. It is the third most common fracture after hip fracture and colles fracture in elderly patients. As the technology has advanced, the elderly people no longer need to be denied effective surgical treatment. AIM OF THE STUDY: In our study we have analysed 20 cases of proximal humeral fractures treated surgically using (PHILOS) proximal humerus locking compression plates admitted at Department of Orthopaedics Government Royapettah Hospital, Chennai from June 2018 to December 2020. The aim of the study was to analyze the functional and radiological outcome and to assess the complications of proximal humeral fractures treated using PHILOS plate. MATERIAL AND METHODS: Patients with proximal humerus fractures, who are skeletally mature and age more than 18 years with Neer’ s two,three and four part fractures were included in the study. Patients with open fractures, pathological fractures, with associated vascular head injury were not included. All patients were evaluated with standard anteroposterior radiographs of the affected shoulder and most of them were further evaluated with Neer’s three view trauma. CT Scan taken if needed. Radiological evaluation of the fractures was done and were classified according to Neer’s four part classification system. 4 patients had two part fractures, 11 had 3 part fractures and 5 had four part fractures. The patients were operated by the standard anterior deltopectoral approach using proximal humerus PHILOS plate. All the patients were reviewed once weekly in the 1st month and once a month after that. During follow up, patients were clinically evaluated for pain and function using DASH score. The minimum follow-up period was three months and maximum follow up period was 18 months. Radiological evaluation of fracture union was observed by serial x rays. RESULTS AND OBSERVATION: Majority of injured patients were males (75%). Free fall at ground level was the most common mode of injury (65%). Neer’s 3 part fracture is the most common type in 55% patient. 4 part fractures accounted for only 5% of patients. Early complications like superficial infection and screw penetration were encountered. Late complications osteonecrosis and joint stiffness were encountered. DASH score was used to assess the functional outcome of our patients. 8 (40%) patients had good functional outcome 10 (50%) patients had satisfactory outcome and 2 (10%) patients had poor outcome. CONCLUSION: Finally we concluded that Accurate anatomical reduction and early fracture fixation are more important to get a good final functional outcome. Use of shorter screws than subchondral screws closer to the joint prevented failure. Adherence to regular and graduated rehabilitation program is the key for good functional outcome