A STUDY ON SURGICAL MANAGEMENT OF PROXIMAL HUMERUS FRACTURES BY PHILOS PLATE

Corresponding Author:
Dr. Kolipaka Venkataswamy,
Home No. 25-7-186,
Vishnupuri, Kazipet,
Warangal-506003, Telangana.
E-mail: drlathavenkat@gmail.com

ABSTRACT

BACKGROUND

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. Due to increasing incidence of high velocity trauma, the fracture pattern in proximal humerus fracture are becoming complicated. It has always been an enigma for the management of such fractures because of numerous muscles attachment and paucity of space for fixing implant in fracture of proximal humerus. The treatment is more controversial for articular fractures, which carry a high risk of the humeral head necrosis. In Neer’s classification there are two part anatomical neck, three-part and four-part fracture and those with dislocation of head of humerus. A review of published result suggests that there is no universally accepted form of treatment. Conservative management may be associated with non-union, malunion resulting in painful dysfunction. The object of the osteosynthesis is to reduce the displacement (usually rotation) of each fragment and hold it in place with an implant, the greater tuberosity fragment which has usually been displaced proximally and rotated upward by rotator cuff muscles inserted into it is fixed to the major humeral head fragment, lesser tuberosity fragment similarly displaced by subscapularis is fixed. Three and four part fractures represent 13% to 16% of proximal humeral fractures. Treatment options for these displaced fractures include open reduction and fixation. Neer recommended open reduction and internal fixation for displaced two and three parts fractures.

The aim of the present study is this study is undertaken to evaluate the functional outcome and complication of proximal humerus fractures treated by PHILOS locking plate.

MATERIALS AND METHODS

Prospective study involving Adults (> 18 yrs.) with proximal humerus fractures admitted to MGM Hospital, Warangal, over a period of 2.5 years. In this study period, 30 cases of fractures of proximal humerus were treated by open reduction and internal fixation. PHILOS locking plate were evaluated.

Inclusion Criteria- Two part, three part, four part proximal humeral fractures, acute fracture, age above 18, patient fit for surgery.

Exclusion Criteria- Below 18, associated humerus shaft fracture, associated neurovascular injury.

RESULTS

In our series, majority of the patients were males, elderly aged, with RTA being the commonest mode of injury involving 2 part, 3 part and 4 part fractures of proximal humerus. The fractures united in all 30 patients. Excellent and satisfactory results were found in 80% of patients with unsatisfactory results in 20% according to Neer’s criteria.

CONCLUSIONS

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 mobilisation and fracture union. The present study was done to evaluate functional outcome and complication following surgical management of proximal humerus fractures treated with PHILOS locking compression plate. From our study, it can be safely recommended that for proximal humerus fractures PHILOS plating is a good choice of surgical treatment.

KEYWORDS                           

Humerus, Proximal, Osteoporosis, PHILOS, Neer’s Classification, Greater Tuberosity.