Functional Outcomes of Proximal Humerus Fractures with PHILOS in a Tertiary Care Setup

Authors

  • Naveed Hussain Khatana Department of Orthopedics, Liaquat National Hospital, Karachi, Sindh, Pakistan.
  • Hafeez ur Rehman Department of Orthopedics, Liaquat National Hospital, Karachi, Sindh, Pakistan.
  • Shahjahan Siyal Department of Orthopedics, Chandka Medical College at SMBBMU, Larkana, Sindh, Pakistan.
  • Usman Mehmood Department of Orthopedics, Liaquat National Hospital, Karachi, Sindh, Pakistan.
  • Saad Iqbal Department of Orthopedics, Liaquat National Hospital, Karachi, Sindh, Pakistan.
  • Abdul Rafay Department of Orthopedics, Liaquat National Hospital, Karachi, Sindh, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v2i02.426

Keywords:

Functional Outcomes, Proximal Humerus Fractures, Prximal Humerus Interlocking, Osteo-Synthesis System

Abstract

Background: Proximal humerus fractures are favorably classified according to AO classification and NEERS classification. Proximal humeral internal locking system (PHILOS) is representative of locking plates. In spite of being superior to conventional plates PHILOS is associated with complications. Objective: To determine the functional outcomes of proximal humerus fractures treated by PHILOS (Prximal Humerus Interlocking Osteo-synthesis system). Material and Methods: Overall 94 patients were included and operated using PHILOS by deltoid splitting approach. Patients were discharged on 3rd postoperative day. Skin staples were removed at 15th day. Arm was kept in polysling for 3 weeks. After 3 weeks pendulum exercises and range of motion exercises were started. Functional outcomes were assessed by Constant shoulder score at 6 weeks and 3 months. Descriptive statistics were calculated. Stratification was done and post-stratification chi square test was applied considering p-value ≤0.05 as significant. Results: Total 68.1% patients were male and 31.9% were female. The mean constant murley’s shoulder score after 6 weeks and 3 months was 57.10±7.02 and 87.54±9.64. as per Neer classification 9.6% had part-II, 81.9% had part-III and 8.55 had part-IV fracture. The functional outcome assessed by constant shoulder score status showed 59.6% had moderate and 40.4% had poor after 6 weeks and after 3 months 74.5% had excellent, 18.1% had good and 7.4% had moderate outcome. Conclusion: In our study, 74.5% patients had excellent, 18.1% had good and 7.4% had moderate functional outcome at end of follow-up after 3 months.

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References

- Fisher, N. D., Driesman, A., Saleh, H., Egol, K. A., & Konda, S. R. (2022). The proximal humerus outcome score at one year (POSY) predicts which patients have poor functional outcomes following operative fixation of proximal humerus fractures. Cureus, 14(7). https://doi.org/10.7759/cureus.26631

- Egol, K. A, Koval, K.J, & Zuckerman, J., D.(2019). Handbook of Fractures. Wolters Kluwer, Gurugram, India.

- Roux, A., Decroocq, L., El Batti, S., Bonnevialle, N., Moineau, G., Trojani, C., ... & De Peretti, F. (2012). Epidemiology of proximal humerus fractures managed in a trauma center. Orthopaedics & Traumatology: Surgery & Research, 98(6), 715-719. https://doi.org/10.1016/j.otsr.2012.05.013

- Court-Brown, C. M., & Caesar, B. (2006). Epidemiology of adult fractures: a review. Injury, 37(8), 691-697. https://doi.org/10.1016/j.injury.2006.04.130

- Jhamnani, R., Dhanda, M. S., & Surana, A. (2023). Study of Functional Outcome and Postoperative Complications Among Proximal Humerus Fracture Patients Treated With Proximal Humerus Internal Locking System (PHILOS) Plating. Cureus, 15(7), e42411. https://doi.org/10.7759/cureus.42411

- Frima, H., Michelitsch, C., Beks, R. B., Houwert, R. M., Acklin, Y. P., & Sommer, C. (2019). Long-term follow-up after MIPO Philos plating for proximal humerus fractures. Archives of orthopaedic and trauma surgery, 139, 203-209. https://link.springer.com/article/10.1007/s00402-018-3063-1

- Ahmad, T., Muhammad, Z. A., & Haroon, A. (2021). Functional outcomes in proximal humerus fractures: A prospective registry-based analysis. Journal of Pakistan Medical Association, 71(7), 1870-1870. https://go.gale.com/ps/i.do?id=GALE%7CA666410524&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00309982&p=HRCA&sw=w&userGroupName=anon%7E9a3b8b7e&aty=open-web-entry

- Launonen, A. P., Lepola, V., Saranko, A., Flinkkilä, T., Laitinen, M., & Mattila, V. M. (2015). Epidemiology of proximal humerus fractures. Archives of osteoporosis, 10, 1-5. https://link.springer.com/article/10.1007/s11657-015-0209-4

- Court-Brown, C. M., Garg, A., & McQueen, M. M. (2001). The epidemiology of proximal humeral fractures. Acta Orthopaedica Scandinavica, 72(4), 365-371. https://doi.org/10.1080/000164701753542023

- Handoll, H. H., Brorson, S., & Rollins, K. E. (2012)Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 12, CD000434.

- Geiger, E. V., Maier, M., Kelm, A., Wutzler, S., Seebach, C., & Marzi, I. (2010). Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthop Traumatol Turc, 44(1), 1-6. https://doi.org/10.3944/aott.2010.2270

- Erasmo, R., Guerra, G., & Guerra, L. (2014). Fractures and fracture-dislocations of the proximal humerus: a retrospective analysis of 82 cases treated with the Philos® locking plate. Injury, 45, S43-S48. https://doi.org/10.1016/j.injury.2014.10.022

- Launonen, A. P., Lepola, V., FLinkkiLä, T., Laitinen, M., Paavola, M., & Malmivaara, A. (2015). Treatment of proximal humerus fractures in the elderly: a systematic review of 409 patients. Acta orthopaedica, 86(3), 280-285. https://doi.org/10.3109/17453674.2014.999299

- Jobin, C. M., Galdi, B., Anakwenze, O. A., Ahmad, C. S., & Levine, W. N. (2015). Reverse shoulder arthroplasty for the management of proximal humerus fractures. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 23(3), 190-201. https://doi.org/10.5435/JAAOS-D-13-00190

- Robinson, C. M., Stirling, P. H., Goudie, E. B., MacDonald, D. J., & Strelzow, J. A. (2019). Complications and long-term outcomes of open reduction and plate fixation of proximal humeral fractures. JBJS, 101(23), 2129-2139. https://doi.org/10.2106/JBJS.19.00595

- Erasmo, R., Guerra, G., & Guerra, L. (2014). Fractures and fracture-dislocations of the proximal humerus: a retrospective analysis of 82 cases treated with the Philos® locking plate. Injury, 45, S43-S48. https://doi.org/10.1016/j.injury.2014.10.022

- Shulman, B. S., Ong, C. C., Lee, J. H., Karia, R., Zuckerman, J. D., & Egol, K. A. (2013). Outcomes after fixation of proximal humerus (OTA type 11) fractures in the elderly patients using modern techniques. Geriatric Orthopaedic Surgery & Rehabilitation, 4(1), 21-25. https://doi.org/10.1177/2151458513498597

- Ong, C. C., Kwon, Y. W., Walsh, M., Davidovitch, R., Zuckerman, J. D., & Egol, K. A. (2012). Outcomes of open reduction and internal fixation of proximal humerus fractures managed with locking plates. American Journal of Orthopedics, 41(9), 407. https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/041090407.pdf

- Doshi, C., Sharma, G. M., Naik, L. G., Badgire, K. S., & Qureshi, F. (2017). Treatment of proximal humerus fractures using PHILOS plate. Journal of clinical and diagnostic research: JCDR, 11(7), RC10. https://doi.org/10.7860/JCDR/2017/26782.10304

- Plath, J. E., Kerschbaum, C., Seebauer, T., Holz, R., Henderson, D. J., Förch, S., & Mayr, E. (2019). Locking nail versus locking plate for proximal humeral fracture fixation in an elderly population: a prospective randomised controlled trial. BMC Musculoskeletal Disorders, 20, 1-13. https://link.springer.com/article/10.1186/s12891-019-2399-1

- Shah, M. R., Shah, M. M., Shah, I. M. (2023). Functional Outcome of Proximal Humerus Fracture Operated with Deltopectoral Approach v/s Deltoid Splitting Approach. Journal of Coastal Life Medicine, 11(1), 892–901. https://www.jclmm.com/index.php/journal/article/view/445

- Owsley, K. C., & Gorczyca, J. T. (2008). Displacement/screw cutout after open reduction and locked plate fixation of humeral fractures. Jbjs, 90(2), 233-240. https://doi.org/10.2106/JBJS.F.01351

- Südkamp, N., Bayer, J., Hepp, P., Voigt, C., Oestern, H., Kääb, M., ... & Konrad, G. (2009). Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate: results of a prospective, multicenter, observational study. JBJS, 91(6), 1320-1328. https://doi.org/10.2106/JBJS.H.00006

- Agudelo Agudelo, J., Schürmann, M., Stahel, P., Helwig, P., Morgan, S. J., Zechel, W., ... & Smith, W. (2007). Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. Journal of orthopaedic trauma, 21(10), 676-681. https://doi.org/10.1097/BOT.0b013e31815bb09d

- Charles, S., &Neer, I. I. (1970). Displaced proximal humeral fractures: Part I. Classification and evaluation. JBJS, 52(6), 1077-1089. https://journals.lww.com/jbjsjournal/abstract/1970/52060/Displaced_Proximal_Humeral_Fractures__PART_I_.1.aspx

- Bayley, K. B., London, M. R., Grunkemeier, G. L., & Lansky, D. J. (1995). Measuring the success of treatment in patient terms. Medical care, AS226-AS235. https://www.jstor.org/stable/3766631

- Wylie, J. D., Beckmann, J. T., Granger, E., & Tashjian, R. Z. (2014). Functional outcomes assessment in shoulder surgery. World journal of orthopedics, 5(5), 623. https://doi.org/10.5312/wjo.v5.i5.623

- Dowrick, A. S., Gabbe, B. J., Williamson, O. D., & Cameron, P. A. (2005). Outcome instruments for the assessment of the upper extremity following trauma: a review. Injury, 36(4), 468-476. https://doi.org/10.1016/j.injury.2004.06.014

- Shields, E., Sundem, L., Childs, S., Maceroli, M., Humphrey, C., Ketz, J., & Gorczyca, J. T. (2015). Factors predicting patient-reported functional outcome scores after humeral shaft fractures. Injury, 46(4), 693-698. https://doi.org/10.1016/j.injury.2015.01.027

- Yian, E., Zhou, H., Schreiber, A., Sodl, J., Navarro, R., Singh, A., & Bezrukov, N. (2016). Early hospital readmission and mortality risk after surgical treatment of proximal humerus fractures in a community-based health care organization. The Permanente Journal, 20(1), 47. https://www.thepermanentejournal.org/doi/pdf/10.7812/TPP/15-065

- Neuhaus, V., Swellengrebel, C. H., Bossen, J. K., & Ring, D. (2013). What are the factors influencing outcome among patients admitted to a hospital with a proximal humeral fracture?. Clinical Orthopaedics and Related Research®, 471, 1698-1706. https://link.springer.com/article/10.1007/s11999-013-2876-z

- Egol, K. A., Ong, C. C., Walsh, M., Jazrawi, L. M., Tejwani, N. C., & Zuckerman, J. D. (2008). Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. Journal of orthopaedic trauma, 22(3), 159-164. https://doi.org/10.1097/BOT.0b013e318169ef2a

- Kirsch, L. B., & Herscovici, D. (2001). Proximal humerus fracture. Journal of Orthopaedic Trauma, 15(2), 146-148. https://doi.org/10.1097/00005131-200102000-00015

- Yadav, U., Bharth, N., Vignesh, V. R., & Chakrawarty, A. (2020). A comparative study of functional outcome following PHILOS plating versus percutaneous pinning in proximal humerus fractures. MedPulse Int J Orthoped, 16, 18-26.

- Jagiasi, J. D., Patel, M. R., Daliya, S. G., Bochare, A., & Vora, M. (2018). Assessment of functional outcome of surgical management of proximal humerus fracture treated with PHILOS plate. International Journal of Research in Orthopaedics, 4(5), 736. https://doi.org/10.18203/issn.2455-4510.intjresorthop20183673

- Ganesan, R. P., Anbu, S., Palaniappan, M., Kolundan, K., Kannan, K., & Subramaniankarunanithi, S. (2017). Elastic stable intramedullary nailing of femoral and tibial shaft fractures in children. Journal of Evolution of Medical and Dental Sciences, 5(71), 5196-5201. https://doi.org/10.14260/jemds/2016/1178

- Pandya, D., & Soni, K. (2020). Analysis of functional outcome in proximal humerus plating (PHILOS) in displaced proximal humerus fracture. Acta Scientific Orthopaedics, 3(11), 37-49. https://doi.org/10.31080/asor.2020.03.0228

- Vijayvargiya, M. (2016). Outcome analysis of locking plate fixation in proximal humerus fracture. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. https://doi.org/10.7860/jcdr/2016/18122.8281

- Bansal, V., Sohal, H., & Bhoparai, R. (2015). Philos plate in proximal humerus fracture–its functional outcome and complications. International Journal of Orthopaedics, 2(3), 317-322. https://doi.org/10.17554/j.issn.2311-5106.2015.02.63

- Vijayanand, A., & Jayasomeswar, N. (2020). Study of functional outcome of surgical management of proximal humerus fracture by various modalities: A two-year study at a tertiary care hospital. International Journal of Research in Orthopaedics, 6(2), 242. https://doi.org/10.18203/issn.2455-4510.intjresorthop20200003

- Kumar, V., Khan, A. A., Shah, R., Shamim, S., Mishra, N. K., & Khan, I. S. (2020). Assessment of functional outcome of PHILOS plate in proximal humerus fracture. Journal of Evidence Based Medicine and Healthcare, 7(26), 1218-1222. https://doi.org/10.18410/jebmh/2020/260

- Geiger, E. (2010). Functional outcome and complications following PHILOS plate fixation proximal humeral fractures. Acta Orthopaedica et Traumatologica Turcica, 44(1), 1-6. https://doi.org/10.3944/aott.2010.2270

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Published

2024-12-31

How to Cite

Functional Outcomes of Proximal Humerus Fractures with PHILOS in a Tertiary Care Setup. (2024). Indus Journal of Bioscience Research, 2(02), 1517-``1525. https://doi.org/10.70749/ijbr.v2i02.426