EVALUATION OF OUTCOME OF PROXIMAL HUMERUS FRACTURES MANAGED WITH PHILOS PLATE

INTRODUCTION: Proximal humeral fractures account for 4 to 5 percentage of all fractures.minimally displaced can be managed non-operatively in adults. Displaced and unstable fractures should be treated surgically to achieve painless shoulder and good range of movement. AIM AND OBJECTIVES: Our study Is to evaluate the clinical, functional and radiological result of operative proximal humerus fractures managed PHILOS Plating. MATERIAL AND METHODS: 26 patients with displaced proximal humeral fractures that were treated by PHILOS plating between June 2018 to December 2019 were included in this study. The Constant-Murley score (CMS) was used to evaluate the outcome. RESULT: Out of 26 patients 9 were male and 17 were female. The mean age was 52 years. The mean surgical time was 88 min. The mean fracture union time was 11.5 weeks. Outcome was excellent in 17 cases, Good in 6 and Fair in 3 cases. CONCLUSION: Fixation with PHILOS is associated with good to excellent outcomes. It gives high rate of union, good range of movement and has minimal complications.

A CASE REPORT ON SALVAGE OF FAILED INTERNAL FIXATION OF PROXIMAL HUMRUS FRACTURE USING FIBULAR STRUT GRAFT.

Proximal humerus fractures are common problems plaguing in geriatric population. Approximately half of all proximal humeral fractures occur due to fall usually at ground level. (Low velocity trauma). In younger individuals fractures occurring because of higher-energy trauma such as a fall from a height, motor vehicle accidents, sports, or assaults. The proximal humerus fracture because of three loading modes: compressive loading of the glenoid onto the humeral head, bending forces at the surgical neck, and tension forces of the rotator cuff at the greater and lesser tuberosities. Most proximal humeral fractures are treated nonoperatively. However, surgical treatment is becoming more popular, with development of modern implant (PHILOS plate). Implant failure is common complication occur due to improper fixation, osteoporotic bone, early mobilization, non-union and varus malalignment. Various modality available for its management i.e., Hemiarthroplasty, reverse shoulder arthroplasty and ORIF + bone graft. IN this case report 60-year male patient with right side proximal humerus fracture treated with PHILOS plating. At 6 week follow up radiograph suggest implant failure. Patient was posted for revision surgery ORIF + platting and fibular strut graft was done.

Functional Outcome and Complications in Management of Proximal Humerus Fractures Operated with Proximal Humerus Locking Plate

@#Introduction: Controversies exist in treatment of proximal humerus fractures as treatment options vary greatly from conservative management, closed pinning, stacked intramedullary nails, plating and hemi-arthroplasty. The purpose of this study is to study the fracture patterns of each case and document the functional outcome and complications post-operative in the management of proximal humerus fractures operated with proximal humerus plate. Materials and Methods: Thirty five patients with closed proximal humerus fractures, above 18 years old, admitted in our tertiary care hospital during the study period were enrolled. Patients underwent open reduction internal fixation with proximal humerus locking plate under general anaesthesia. Post-operative patients were assessed using Constant and DASH scores. Complications were recorded. Results: In our study the absolute Constant score of the study population increases at three months and six months and was found to be significant. Mean Constant score for 4- part fractures was 45.6 which were inferior as compared to 2-part and 3-part fractures (43.1 and 44.6, respectively). The mean Constant score at six months was 51.80 +/- 6.71. All three types of proximal humerus fractures showed significant improvement in the mean DASH score over our study period of six months and was found to be significant. Mean DASH score at six months was 27.97+/-12.84. Out of the 35 cases in the study two had complications. One had implant failure (Neer’s type 3, 60-year-old female) and one had varus collapse (Neer’s type 3, 45-year-old male). Conclusion: Due to angular stability and effective maintenance of the intraoperative fracture reduction during follow-up period, early post-operative mobilisation is possible which helps the patient to attain better shoulder range of motion and return to activity faster.

Three-dimensional finite element analysis on the novel locking plate and AO-PHILOS plate for fixing four-part proximal humeral fractures / 医用生物力学

Objective To compare biomechanical performance of four-part proximal humeral fractures fixed by novel locking plate or by AO-PHILOS plate. Methods The finite element fixation models of both the novel locking plate and AO-PHILOS plate for four-part proximal humeral fractures were established, respectively. The maximum Von Mises stress and displacement under 4 different functional positions of shoulder abduction in the two fixation models were compared by finite element analysis. Results The maximum displacement in shoulder abduction of 0°,30°,60°,90° were 6.644, 7.079, 5.850, 3.005 mm, respectively, in novel locking plate fixation model, and 6.293, 6.826, 5.774, 3.023 mm, respectively, in AO-PHILOS plate fixation model. Since the maximum displacements in both fracture fixation models were similar, it indicated that there was no significant difference in the stability for fixing proximal humeral fracture. The maximum Von Mises stress in shoulder abduction of 0°,30°,60°,90°were 1 033.0, 904.1, 888.1, 1 062.0 MPa in novel locking plate fixation model, while in AO-PHILOS plate fixation model, it showed 743.1, 692.4,486.4,393.5 MPa, respectively. During the process of shoulder abduction, the total stress in both fracture fixation models gradually decreased, but the new locking plate decreased in a larger range, showing an obvious stress dispersion. Conclusions Both the novel locking plate and AO-PHILOS plate can be used as internal fixation treatment for complex four-part proximal humeral fractures with no significant difference in stress distribution, and both showing a stable fixation effect. For fixing proximal humeral fractures with osteoporosis combined with the great and less tuberosity, the novel locking plate has an advantage over AO-PHILOS plate due to its unique anatomical wings and better fixing effect.

Conformity of Proximal Humerus Internal Locking Plate System (PHILOS) and Anatomic Features of Proximal Locking Screws: Cadaveric Study / 대한정형외과학회잡지

PURPOSE: The purpose of this cadaveric study was to evaluate the conformity of the anatomically preshaped proximal humerus internal locking plate system (PHILOS) to the humeri of the Korean and anatomical features of nine locking screws for the proximal humerus. MATERIALS AND METHODS: This study included 20 adult humeri (average length 30.2 mm) with no deformity or previous surgery. PHILOS was applied to the lateral surface of the proximal humerus according to the contour. Then, the distance from the outer surface of the plate to the greater tuberosity and bicipital groove was measured. After K-wires were passed through the proximal locking guide, the intra-osseous length of K-wire and the configuration of the K-wire exit were evaluated. RESULTS: The overall conformity of PHILOS was excellent at the lateral aspect of the proximal humerus. The tip of the plate had an average distance of 3.6 mm (range, 1.4-6.6 mm; standard deviation [SD], 1.27) from the greater tuberosity and 2.5 mm (range, 0.0-4.6 mm; SD, 1.24) at the bicipital groove and the average intra-osseous length of K-wire through the locking guide was 41.1 mm (range, 23.5-53.7 mm). K-wires were evenly penetrated through the humeral head. On H8 and H9, the bottom hole of PHILOS is closely located at the most inferior area of the humeral articular surface. The bicipital groove was pierced by K-wires of H5, which was the middle hole of PHILOS in four cases (20%). CONCLUSION: PHILOS had excellent conformity with the proximal humerus and K-wires through the locking guide were evenly penetrated through the humeral head. However, much care should be taken in piercing of the bicipital groove in H5.

Long Term Results of PHILOS Plating and Percutaneous K-Wire Fixation in Proximal Humerus Fractures in The Elderly

This is a report of a study on the long term results of PHILOS plating and percutaneous K-wire fixation in a prospective series of proximal humerus fractures in elderly patients. We reviewed a total of 60 patients with proximal humerus fractures in 30 patients (Group 1), who were treated by open reduction and internal fixation with Proximal Humeral Internal Locking System (PHILOS) plate and 30 patients(Group 2) who were treated with percutaneous K-wire fixation. Functional outcome was assessed using Visual Analogue Scale(VAS) and Constant-Murley Score. Mean Constant-Murley score was 84.6 points (range: 61-100) in Group 1 and - 76.4 points(range:56-100) in Group2 at final follow up. Values varied depending upon the fracture type with worst in 4-part fractures. Mean VAS Score was 2.6(range:0-10) in Group 1 and 3.8(range:0-10) in Group 2. We obtained satisfactory results in both the groups, with each procedure having its advantages and shortcomings. We found that PHILOS plate fixation provided stable fixation with minimal implant problems and enabled early range-ofmotionexercises to achieve acceptable functional results. Fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasiveness and soft tissue dissection.

Minimally invasive percutaneous plate osteosynthesis for the treatment of proximal humerus fractures in osteoporotic patients with Philos plate.

Introduction: To investigate the effect of minimally invasive percutaneous plate osteosynthesis for treatment of proximal humerus fractures in osteoporotic patients with philos plate. Methods: A prospective study was conducted at Department of Orthopedics, M.M.Medical College, Mullana Ambala, from July 2005 to November 2010. A Total of 108 cases of proximal humerus fractures were treated with minimally invasive percutaneous plate osteosynthesis with philos plate. According to Neer classification, 89 cases had two part fractures, 19 had tree part fractures. Results: All the 108 cases were followed up ranging from 12 to 18 months with an average of 14 months. Radio graphically, union was observed in 92 patients at the end of 10 weeks. In 10 patients, times to union were 16 weeks. Six patients underwent autogenous bone grafting because of nonunion after 16 weeks. The mean Constant-Murley score was 86 (range 74-92). The functional results of the shoulder, according to Muley scores, were classified as excellent in 85.15% cases, good in 9.25% cases and fair in 5.55 cases. Conclusion: Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humerus fractures in osteoporotic patients with philos plate shows good results and less complication.

Artrodesis tibiotalocalcanea con placa philos: experiencia en el Hospital Militar Central. Enero 2007 a diciembre de 2009 / Tibiocalcaneal arthrodesis with philos plate: experience in the Hospital Militar Central - January 2007 to December 2009 / Artrodese tibiotalocalcânea com placa philos: experiência no Hospital Militar Central. Janeiro de 2007 a dezembro de 2009

Estudio descriptivo observacional, retrospectivo tipo serie de casos, realizado entre enero de 2007 y diciembre de 2009 en el Hospital Militar Central. Fueron tratados 21 pacientes con artrosis de la articulación tibio talar y subtalar de etiología diversa, con seguimiento mínimo de 6 meses. Se evaluó; la función pre operatoria y post operatoria por medio de la escala AOFAS, el dolor mediante la escala visual análoga, el tiempo de consolidación con controles radiográficos, el tipo de injerto utilizado y las complicaciones asociadas. Se encontraron como complicaciones 2 pacientes con infección superficial, que requirió manejo con antibiótico endovenoso, y 2 pacientes con retardo en la consolidación que requirieron cirugía de revisión. Los resultados obtenidos demuestran que la artrodesis tibiotalocalcanea con placa philos es un excelente método de fijación (90,4% consolidación) en pacientes con artrosis del tobillo y sub talar y mala calidad ósea...

Descriptive, observational, retrospective, case-series study conducted between January 2007 and December 2009 in the Hospital Militar Central. Twenty one patients with tibiotalar and subtalar joint arthrosis of diverse etiology were treated, with follow-up of at least 6 months. The following facts were assessed: pre-operatory and post-operatory function through the AOFAS scale, pain according to the visual analogue scale, time to consolidation by radiographic controls, type of used graft and associated complications. Complications were found in 2 patients with superficial infection which required management with intravenous antibiotic, and 2 patients showing consolidation delay who required revision surgery. The obtained results demonstrate that tibiotalocalcaneal arthrodesis with Philos plate is an excellent fixation method (90.4% consolidation) in patients with ankle and subtalar arthrosis and poor bone quality...

Estudo descritivo observacional, retrospectivo tipo série de casos, realizado entre janeiro de 2007 e dezembro de 2009 no Hospital Militar Central. Foram tratados 21 pacientes com artrose na articulação tíbio talar e subtalar de etiologia diversa, com acompanhamento mínimo de 6 meses. Foi avaliada a função pré-operatória e pós-operatória por meio da escala AOFAS, a dor mediante a escala visual análoga, o tempo de consolidação com controles radiográficos, o tipo de enxerto utilizado e as complicações associadas. Foram encontradas como complicações 2 pacientes com infecção superficial, que requereram tratamento com antibiótico endovenoso, e 2 pacientes com retardo na consolidação que requereram cirurgia de revisão. Os resultados obtidos demonstram que a artrodese tibiotalocalcânea com placa philos é um excelente método de fixação (90,4% consolidação) em pacientes com artrose do tornozelo e sub-talar e má qualidade óssea...

A retrospective study after treatment of proximal humeral fractures with locking plates / 国际外科学杂志

Objective The purpose of our study was to evaluate the treatment of proximal humeral fractures with AO Philos plate. Methods From June 2007 to May 2009, 29 cases of proximal humeral fractures were fixed with AO Philos plate. According to Neer classification, 11 cases were two-part fractures, 16 cases three-part fractures and 2 cases four-part fractures. Results Twenty-nine cases were followed 9-16 months (averaging 11.3 months). The results were evaluated with Neer's evaluation system: 13 patients were graded as excellent,12 as good, 4 as fair. Conclusion AO Philos plate is less invasive comparing with traditional method. It can provide solid fixation, permit early functional rehabilitation and lead to a compromising clinical result.