Syed Arsalan Haider Bukhari.
Proximal Humeral Fractures: An Experience With PHILOS Fixation.
J Surg Pak Jan ;19(2):62-5.

Objective: To evaluate functional outcomes and complications after open reduction and internal fixation of displaced proximal humerus fractures by proximal humeral internal locking osteosynthesis system (PHILOS). Study design: Cross sectional study. Place & Duration of study: Department of orthopaedics at CMH Abbottabad, From October 2011to September 2012. Methodology: Patients with displaced proximal humerus fractures treated with proximal humerus locking plate were included in the study. Patients were followed for a minimum period of ten months. Neer`s classification was used to group the fractures. Open fractures and infected injuries were not included in the study. Functional evaluation was done according to the ConstantMurley scoring system. Results: Eighteen patients (M=14, F=4) were managed during the study period. Thirteen patients were between the ages of 20-45 year (M=12, F=1) and 5 patients were between 46-60 years (M=2, F=3). Seven patients (M=6, F=1) had 2-part fractures, 5 patients (M=3, F=2) had 3-part fractures, and 6 patients (M=5, F=1) had 4-part fractures. The mean follow-up period was 10 ± 2 months. Thirteen (72.2%) patients had excellent to good results, 16.6% (n=3) had fair, and 11.2% (n=2) had poor result. Average Constant Murley scores for 2-part (9 ± 1) and 3-part fractures (14 ± 2) were significantly superior to those of 4-part fractures (24 ± 2) (p value = 0.002 and 0.018, respectively). Difference between 2-part and 3-part fractures was not significant (p value=0.023). There was no significant difference between younger (=45 year) and older patients (>45 year). Complications encountered in this series were reduced shoulder movements in 11% (n=2), screw perforation in 5.5% (n=1), varus mal-reduction 11% (n=2), plate impingement in 11% (n=2), infection in 5.5% (n=1). No non-union and malunion occurred in this study. Conclusions: Proximal humerus locking plate gives reliable fixation for 2-part and 3-part fractures of proximal humerus. Its’ use in Neer’s 4-part fractures was associated with poor clinical outcome.

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