FUNCTIONAL EVALUATION OF PROXIMAL HUMERUS FRACTURES TREATED BY PHILOS PLATING

Abstract

Introduction Proximal humeral fractures are now recognized as an increasingly common fracture, accounting for 4%–5% of all fractures and 45% of all humeral fractures [1,2]. It is the third most common fracture, in people above 65 years of age, after fractures of the hip and distal radius [3]. These fractures have a bimodal distribution occurring either in young people after high energy trauma or in those older than 50 years with low- velocity injuries like simple fall [3]. 85% of these fractures are minimally displaced and are effectively treated with immobilization followed by early motion. The remaining 15% of these are either displaced or unstable. These fare poorly with non-operative treatment and are better treated with surgical intervention. Surgical treatment is necessary especially in young patients and active elderly people in order to prevent minimal dislocations of tuberosity or articular surface from compromising the long-term articular function. This study was planned to evaluate the outcome of proximal humerus fractures managed with PHILOS plate after approval by the Institutional Ethical Board. Aims And Objectives To evaluate the efcacy of PHILOS plate in the treatment of proximal humeral fractures and assess its functional outcome. To assess any complications that could arise postoperatively Early rehabilitation of the patient Methods And Materials Study Design: Hospital Based Prospective study. Study Period: October 2019 to September 2022. Study Setup: Study is conducted in Department of Orthopaedics, Andhra Medical College, Visakhapatnam. Study Population: Patients attending emergency/orthopaedic OP and admitted in department of orthopaedics in King George Hospital, Visakhapatnam with proximal humerus fractures and are classied according to Neer's Classication Sample Size: 30 patients admitted in the Department of Orthopaedics, King George Hospital, Visakhapatnam with proximal humerus fractures in the above said period. Results We have included 30 proximal humeral fractures in our study. Males dominated and left side is more common than right. Domestic falls are common than road trafc accidents. 2-part fractures are more common than 3- and 4-part fractures. All of them are treated with PHILOS stable angled plate. Complications like stiffness, screw penetration and supercial infection occurred in our study which are dealt appropriately. Signicantly, we could prevent varus malunion which is notable in our study. Rehabilitation started early with pendulum exercises and could achieve good range of useful movements for most of the cases. Average range of radiological union is 13.5 weeks. Conclusion PHILOS plate, stable, angled construct is used in all our cases and the results evaluation done with Constant Murley score which ranged 54 to 87. Our average score is 67.43 which is in concurrence with few of the studies. The rehabilitation after operation started early with pendulum exercises as soon as the patients compliance within the limits of pain. The range of movements in our study, abduction maximum range obtained is 120 to 150 degrees and forward exion 90 to 120 degrees and rotations average score is 7. Though we have few complications like stiffness of shoulder (5), AVN (1), intraarticular screw penetration (1), supercial infection (1) and subacromial impingement (1), we have dealt with all these complications appropriately. Signicantly, varus malunion did not occur in our study