PHILOS Plate fixation for displaced fractures of the Proximal Humerus
Authors: M Webb, L Funk
References: SICOT, 2005
Controversy persists concerning the preferred treatment of displaced fractures of the proximal humerus. The results of plate fixation have been mixed, with worse results for three and four part fractures. The present study was undertaken to evaluate the results to date of open reduction and internal fixation of fractures of the proximal humerus using the PHILOS plate (Stratec, UK). 25 Patients with a mean age of 49.5 (19-80) have been treated using the PHILOS plate - 22 for acute fractures, 2 for nonunion and 1 for malunion. This included 10 2-part, 13 three-part and 2 four-part fractures. In three cases the glenohumeral joint was dislocated and there was a head-splitting fracture in one case. All the nonunions had supplementary bone grafting, none of the acute fractures were grafted. Mean follow-up period was 12 months (3-20). The mean Constant score was 70.7 (91 – 26). Patient satisfaction score was 76% (30-100) and the mean pain score was 12.9 (5-15). 86% of the patients reviewed after 6 months had returned to their previous level of function. Results improved with time and the higher Constant Scores seen after 12 months. There was no difference in the results between the two and three part fractures. To date there have been no non-unions or AVN. Complications include 1 deep infection, 1 tuberosity failure and 1 fracture collapse( functionally patient doing well). In conclusion, PHILOS plate osteosynthesis is a suitable procedure for displaced and ununited fractures of the proximal humerus. These results are comparable or better than other reported fixation devices for the proximal humerus.