Outcomes in Patients with Proximal Humerus Fractures Undergoing Open Reduction and Internal Fixation with Proximal Humerus Locking Plate

Abstract

Background & Objective: Despite of conservative management for proximal humeral fractures, open

reduction and internal fixation with proximal humeral locking plate has become the most frequent treatment

for these fractures especially in elderly and osteoporotic population. A lot of complications are associated with

proximal humerus internal locking system (PHILOS) plate including intra articular screw penetration, screw

cut out, varus malunion, loss of reduction, nonunion and infections. Efforts have been made to improve the

locking plate fixation technique and strengthen the fixation more resilient to head collapse, screws cut out,

screw penetration and loss of fracture reduction.

Methods: It was an observational study conducted in the Department of orthopaedic surgery, Services

Hospital Lahore. About 30 patients having isolated proximal Humerus fracture with age between 40-75 years

being treated with promixal humral locking plate were included in the study after permission from ethical

review board. Patient with head, spine, abdomen and chest injury or poly trauma were excluded. There were

Eight with 2 – part, 15 with 3- part fractures and 7 with 4- part fractures. All these patients were followed at

interval of 3 weeks, 6 weeks, 3 months, 6 months and at one year.

Results: In all our 30 patients, fracture united 3 months after the surgery. In 05 patients there were screw

penetration in the shoulder joint. In these 05 patients, 03 patients developed avascular necrosis (A VN) and

underwent shoulder arthroplasty. Loss of reduction was present in 04 patients in whom the revision surgery

was done with addition of bone graft. Range of movements were significantly less in patients with 4- part

fracture( forward elevation was 95 degree and head shaft angle was 100 degree in these patients while

external rotation was 22 to 30, in rest of 35 patients it was within the normal range. Mean DASH score

(Disabilities of Arm, Shoulder and Hand) after 6 weeks was 3.2 – 58.4 while after one year at the end of final

follow up it was 13.3 – 48.6.

Conclusion: Our results reveal that PHILOS fixation technique is an acceptable stabilization procedure for

proximal humeral fractures. One must be aware of potential hardware complications. For unstable proximal

humerus fractures locking plates is a reasonable option especially in 3- part and 4- part fractures in osteoprotic

bone. But at the same time it has got high complication rate like screw penetration in the joint, loss of fracture

reduction and varus malunion etc.