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Functional and Radiological Outcome of Proximal Humerus Fractures Treated with Proximal Humerus Internal Locking
Panthala Priyan Sathavu1, Prem Kumar Kothimbakkam1, P Bala Murugan2
1Department of Orthopaedics, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India.
Insights
The proximal humerus internal locking osteosynthesis (PHILOS) plate offers stable fixation for displaced proximal humerus fractures, enabling early patient mobilization and good functional outcomes. This surgical approach is particularly effective for Neer
Area of Science:
- Orthopedic Surgery
- Traumatology
- Biomedical Engineering
Background:
- Proximal humerus fractures are common, particularly in the elderly, often leading to pain, stiffness, and functional loss with non-operative management.
- Displaced fractures require effective treatment to restore shoulder function and prevent long-term complications.
Purpose of the Study:
- To evaluate the functional and radiological outcomes of displaced proximal humerus fractures treated with the proximal humerus internal locking osteosynthesis (PHILOS) system.
- To assess the efficacy of the PHILOS plate in achieving stable fixation and promoting early mobilization.
Main Methods:
- A study involving 20 patients (18-75 years) with displaced proximal humerus fractures (Neer's 2, 3, or 4-part, or associated with dislocation) treated with the PHILOS plate between April 2022 and April 2024.
- Patients were followed up at 4 weeks, 12 weeks, and 6 months, with functional outcomes assessed using the Constant-Murley Shoulder score.
Main Results:
- Excellent functional outcomes were observed in 7 patients, good in 10, moderate in 2, and poor in 1, with a mean Constant-Murley score of 81.26 at final follow-up.
- Neer's 2- and 3-part fractures demonstrated better functional and radiological outcomes compared to 4-part fractures.
- The PHILOS plate allows for more screw fixation points, enhancing stability for humeral head fractures.
Conclusions:
- Surgical treatment of proximal humerus fractures, particularly with the PHILOS plate, provides significant stability, facilitates early mobilization, and leads to a good range of motion.
- The PHILOS system is a viable option for managing displaced proximal humerus fractures, offering improved outcomes over conventional plates.
- Early mobilization and stable fixation are crucial for optimal recovery following proximal humerus fractures.
Introduction:
Fractures of the proximal humerus are the second most common upper extremity fracture and the third most common fracture, after hip and distal radial fractures. The fractures can occur at any age, but the incidence rapidly increases with age. Common complications following non-operative management of proximal humeral are pain, stiffness, and loss of function. The following study was conducted to evaluate the functional and radiological outcome of displaced proximal humeral fractures treated with the proximal humerus internal locking osteosynthesis system (PHILOS).
Materials And Methods:
The study was conducted in patients treated for displaced proximal humerus fracture (Neer's 2-part, 3-part, 4-part, and associated with dislocation) between the period of April 2022-April 2024. Twenty proximal humerus fracture patients were taken into the study; all were fixed with PHILOS plate. Patients' ages ranged from 18 to 75 years, with a mean of 53.6 years.
Results:
In our study, the sample size of twenty patients of proximal humeral fractures. 10 were males and 10 were females. The patients' ages ranged from 18 to 75 years, with a mean age of 53.6 years. The causes of fractures were self-fall in 12 patients and road traffic accident in 8 patients. Fourteen fractures involved the right side and 6 involved the left. Patients were followed up from 4 weeks, 12 weeks, and 6 months. Functional outcome was rated as per Constant-Murley Shoulder score, we got excellent results in 07 patients, good in 10 patients, moderate in 02 patients, and poor in 01 patient. The mean Constant-Murley score of this study at the end of the final follow-up period was 81.26.
Conclusion:
The majority of proximal humerus fractures in elderly people results from fall on outstretched hand in an osteoporotic bone. As PHILOS plate has options for more number of screws for humeral head than conventional locking plate, it will lead to more stable fixation of fracture fragments and early mobilization of the patients. The functional outcome of Neer's 2- and 3-part fractures is better than Neer's 4-part fractures. The radiological outcome, assessed through quality of reduction and bony union, is better in Neer's 2- and 3-part fractures as compared to Neer's 4-part fractures. We concluded that proximal humeral fractures, when treated surgically, especially using the PHILOS plate, provided stability, early mobilization, and good range of motion.
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