FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURE FIXATION USING PHILOS

Abstract

Background

Second only to wrist fractures, humerus fractures in the proximal area of the bone are the most common upper-extremity fractures in people 65 and older (4-5 percent of all fractures). Tension band wiring, transosseous suture fixation, conventional plate and screw fixation, half-replacement arthroplasty and locking plates such as the proximal interlocking system are some of the surgical procedures used to treat proximal fractures of the humerus (PHILOS). Surgery with PHILOS has been proven to be the most angularly stable, need less dissection, and hence cause less damage to the blood supply. It has also been reported to have a low failure rate. It is the goal of this study to evaluate how proximal humerus fracture repair procedures affect functional outcomes.

Methodology

From the 14th of December 2016 to the 13th of June 2017, this descriptive case study was carried out in the department of Orthopedics at the Aga Khan University Hospital in Karachi. The information was gathered from medical records of patients using a technique known as non-probability consecutive sampling. We included patients with proximal humeral fractures with displacement that were classified as Neer types 2, 3, or 4, as well as fractures involving osteopenic bones. Using the constant Murley score, the functional result was assessed at 12 weeks after the start of the study.

Results

A total of 37 patients were registered with humerus fracture history. The mean age of patients was 48 ± 13.59 years. There were 19 (51.4%) male and 18 (48.6%) female cases with 32 (86.5%) dominant right hand. Out of 37 patients, 16 (43.2%) presented with a fracture of right humerus and 21 (56%) with left sided fracture. There were 24 (64.9%) Neer’s type2 fractures, 11 (29.7%) Neer’s type 3 fractures and 2 (5.4%) Neer’s type 4 fractures. Outcome of PHILOS was acceptable in 34 (91.9%) of patients while unacceptable in 3 (8.1%). There was no association between outcome of humerus fractures managed by PHILOS and age (p-value: 0.27), dominant side of fracture (p-value: 0.13), Neer’s type of fracture (p-value: 0.98).

Conclusion

Our results show that the use PHILOS is associated with good to excellent functional outcome that does not jeopardise the broken union.