Four part Proximal Humerus Fractures Treated Using PHILOS Plating - Evaluation of clinical and functional outcome

Abstract

Proximal humerus fractures are a significant clinical concern, particularly among the elderly due to osteoporosis and the high incidence of falls, as well as in younger individuals due to trauma. These fractures account for about 5% of all fractures and can severely impact shoulder function and quality of life. Effective management is crucial to ensure proper healing and restore function. The Proximal Humerus Internal Locking System (PHILOS) plate has gained popularity as a surgical intervention due to its ability to provide stable fixation and allow early mobilization. However, despite its benefits, complications such as screw perforation, infection, and hardware-related issues remain concerns. This study aims to evaluate the clinical outcomes of PHILOS plating for proximal humerus fractures, focusing on functional recovery, radiographic healing, and complication rates, to better guide treatment strategies in orthopedic practice.

Methods

This retrospective cohort study was conducted at SBMCH, chrompet,  chennai from  January 2024 to August 2024. A total of 30 patients who met the inclusion criteria were included in the study. Inclusion criteria were patients aged 50 and older, diagnosed with four part proximal humerus fractures and treated with PHILOS plating. Exclusion criteria included non traumatic fractures or treated with other operative methods.

All patients underwent surgical management using the PHILOS plate. A deltopectoral approach is used. Fracture reduction was achieved under fluoroscopic guidance, and the PHILOS plate was applied and secured with locking screws. Postoperatively, patients were immobilized in a sling for 2-3 weeks, followed by a structured rehabilitation program focusing on gradual range of motion and strengthening exercises.

Functional outcomes were assessed using different scoring systems at regular intervals postoperatively. Radiographic healing was evaluated using serial radiographs to assess fracture union and alignment. Complications were recorded and categorized as implant-related, infection, non-union, malunion, or shoulder stiffness.

Results

The study included a total of 30 patients, with a mean age of [60+/-10] years. There were [21] males and [9] females. The mean CMS  was [80%] at 12 months. The mean ASES score at 12 months was 83.3%. Significant improvement in functional scores was observed from 6 to 12 months (p < 0.05).

A total of [90]% of fractures achieved radiographic union by 12 months. The mean time to radiographic union was [10-16] weeks. All fractures maintained satisfactory alignment postoperatively.

The overall complication rate was [33.3]%. Implant-related complications included screw perforation in [3] patients and plate loosening in [3] patients. Infection occurred in [1] patients, treated successfully with antibiotics. Non-union was observed in [1] patients, requiring revision surgery. Malunion was observed in [0] patients, with minimal functional impact. Shoulder stiffness occurred in [1] patients, managed with physical therapy.

Conclusion

PHILOS plating is an effective surgical method for treating proximal humerus fractures, providing stable fixation and good functional outcomes. Although complications can occur, they are manageable with appropriate intervention. The study demonstrates significant improvement in functional scores and high rates of radiographic union within 12 months postoperatively. To confirm these results and enhance patient treatment, more research with bigger sample sizes and extended follow-up times is advised.