Praveen Sivakumar K1, Syam Sunder B2, Manikumar C. J3
BACKGROUND
Techniques for treating complex proximal humeral fractures vary and include fixations using tension bands, percutaneous pins, bone suture, T-plates, intramedullary nails, double tubular plates, hemiarthroplasty, plant tan humerus fixator plates, Polaris nails and blade plates. Complications of these techniques include cutout or back out of the screws and plates, avascular necrosis, nonunion, malunion, nail migration, rotator cuff impairment and impingement syndromes. Insufficient anchorage from conventional implants may lead to early loosening and failure, especially in osteoporotic bones. In general, nonoperative treatment of displaced three and four-part fractures of the proximal humerus leads to poor outcome due to intraarticular nature of injury and inherent instability of the fragments. Comminuted fractures of the proximal humerus are at risk of fixation failure, screw loosening and fracture displacement. Open reduction and internal fixation with conventional plate and screws has been associated with unacceptably high incidence of screw pull out. PHILOS (the proximal humeral internal locking system) plate is an internal fixation system that enables angled stabilisation with multiple interlocking screws for fractures of the proximal humerus.
MATERIALS AND METHODS
30 patients with proximal humerus fractures who were admitted in the Department of Orthopaedics, Government General Hospital, Kakinada, during the period November 2014 - November 2016 were taken up for study according to inclusion criteria. All patients were treated with PHILOS plate. These proximal humerus fractures were classified according to Neer’s classification. Patients were followed up at 6 weeks, 12 weeks and 6 months’ interval. Functional outcomes for pain, range of motion and muscle power and function were assessed using the Constant-Murley scoring system. Collected data analysed with independent t-test and ANNOVA test.
RESULTS
The outcome of the study was 1 case (3.33%) had excellent result, 12 cases (40%) had good results, 12 cases (40%) had moderate results and 5 cases (16.66%) had poor results. Collected data analysed with independent t-test and ANNOVA test. In our study, T-test value was 8.529. Probability (P value) was <0.001, which was significant.
CONCLUSION
The results demonstrate both potential benefits and problems of using the PHILOS plate. We obtained good functional results and bone healing in a vast majority of our patients. There was no statistical difference in the functional outcome between the fracture types at a minimum of 18 months postoperatively. However, we caution all surgeons on the high potential for complications and hence the chances reoperation with its use.
