Philos Plating for Proximal Humeral Fractures: Outcome of 41 Consecutive Fixations
DOI:
https://doi.org/10.71637/tnhj.v25i3.1119Keywords:
Proximal Humeral fractures, Neer’s score, PHILOS plate, Fracture fixationAbstract
Background: Proximal Humeral fractures (PHFs) are a growing concern in older adults. Proximal Humeral Internal Locking System (PHILOS) plate has been designed to overcome the challenges of traditional fixation methods. This study assesses the clinical and radiological outcomes of PHFs treated with PHILOS plate in Nigeria.
Methods: A retrospective study on 41 patients with PHFs treated with PHILOS plating between January 2018 and December 2020. Inclusion criteria were adults who had PHFs with complete follow-up data. We evaluated time to radiological union, Neer's shoulder scores, range of motion (ROM) at union and post-operative complications. Data was analyzed using descriptive statistics and chi- square testing with significance set at p ≤ 0.05.
Results: Most patients (87.7%) were above 50 years with a female predominance (58.5%). Falls were the most common mechanism of injury (78%). Most fractures were classified as Neer 3- part (65.9%). Radiological union was achieved within 14 weeks in 82.9% patients. At union, 51.2% of patients attained a Neer's score > 89 with flexion and abduction > 160° in 75.6 % and 73.2% respectively. Forty-one percent of patients had subacromial impingement being the most common complication, followed by screw pull-out, superficial infection and reoperation (7.3%).
Conclusion: PHILOS plate yields dependable fixation and satisfactory functional outcomes for proximal humeral fractures especially in elderly patients. While there are some complications, the benefits of early union and excellent shoulder function support its use as an effective operative strategy. Long-term follow-up is necessary to better assess the avascular necrosis and implant longevity
Downloads
References
Neer CS II, Rockwood CA. Fractures and dislocations of the shoulder, in Rockwood and Green: Fractures in adults. Philadelphia, PA: Lippincott; 1984. pp. 675–721.
Launonen AP, Lepola V, Flinkkilä T, Strandberg N, Ojanperä J, Rissanen P, Malmivaara A, Mattila VM, Elo P, Viljakka T, Laitinen M. Conservative treatment, plate fixation, or prosthesis for proximal humeral fracture. A prospective randomized study. BMC Musculoskelet Disord. 2012;13:167. https://doi.org/10.1186/1471-2474-13-167. PMID: 22954329; PMCID: PMC3520878.
Olsson C, Nordqvist A, Petersson CJ. Increased fragility in patients with fracture of the proximal humerus: a case control study. Bone. 2004;34(6):1072–7. https://doi.org/10.1016/j.bone.2004.01.009. PMID: 15193555.
Kale A, Sharma P, Kuity K, Muneer MT, Verma A, Kaneria S. A Study of Functional Outcome and Assessment of Role of Proximal Humerus Internal Locking System (Philos) Plating in Elderly Population with Proximal Humerus Fracture: A Case Series. J Orthop Case Rep. 2024 Oct;14(10):236-242. doi: 10.13107/jocr.2024.v14.i10.4876. PMID: 39381311; PMCID: PMC11458246.
Neer CS II. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res. 2006;442:77–82. https://doi.org/10.1097/01.blo.0000198718.91223.ca. PMID: 163947
Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001; 72(4):365–71. https://doi.org/10.1080/000164701753542023.
Iannotti JP, Ramsey ML, Williams GR, Warner JJP. Nonprosthetic management of proximal humeral fractures. J Bone Joint Surg Am. 2003;85:1578–93.
Zyto K. Non-operative treatment of comminuted fracture of proximal humerus in elderly patients. Injury. 1998;29(5):349–52. doi: 10.1016/s0020-1383(97)00211-8.
Russo R, Lombardi LV, Ciccarelli M, Giudice G, Cautiero F. A new osteosynthesis device for the treatment of proximal humerus fractures. Description of the technique and preliminary results. Chir Organi Mov. 2008;91(1):27–34. doi: 10.1007/s12306-007-0005-4.
Gavaskar AS, Karthik BB, Tummala NC, Srinivasan P, Gopalan H. Second generation locked plating for complex proximal humerus fractures in very elderly patients. Injury. 2016;47(11):2534–38. doi: 10.1016/j.injury.2016.08.010.
Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective myulticenter analysis. J Orthop Trauma. 2009;23(3):163–72. doi: 10.1097/BOT.0b013e3181920e5b.
Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21(3):185–91. doi: 10.1097/BOT.0b013e3180333094.
Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humerus fractures corrected. J Bone Joint Surg Am. 2008;90(2):01–06. doi: 10.2106/JBJS.F.01351.
Dewarrat A, Terrier A, Barimani B, Vauclair F. Comparison of the ALPS and PHILOS plating systems in proximal humeral fracture fixation - a retrospective study. BMC Musculoskelet Disord. 2023 May 10;24(1):371. doi: 10.1186/s12891-023-06477-9. PMID: 37165381; PMCID: PMC10170861
Srikanth, S., Reddy, A. V. K., & Omkarnath, G. (2019). A study of proximal humerus fractures treated by PHILOS plating in a tertiary care hospital. International Journal of Research in Orthopaedics, 5(5), 838–842.
Geiger EV, Maier M, Kelm A, Wutzler S, Seebach C, Marzi I. Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthop Traumatol Turc. 2010;44(1):1-6. doi: 10.3944/AOTT.2010.2270. PMI
Agrawal U, K. V B, Rao H, et al. (June 26, 2024) Assessment of Functional Outcome and Postoperative Complications in Proximal Humerus Fracture Patients Managed with Proximal Humerus Internal Locking System (PHILOS) Plating. Cureus 16(6): e63250. doi:10.7759/cureus.63250
Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, Kohut G, Ekelund A, Muller M, Audigé L, Babst R. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009 Mar;23(3):163-72. doi: 10.1097/BOT.0b013e3181920e5b. PMID: 19516088.
Siffri PC, Peindl RD, Coley ER, Norton J, Connor PM, Kellam JF: Biomechanical analysis of blade plate versus locking plate fixation for proximal humerus fractures: comparison using cadaveric and synthetic humeri. J Orthop Trauma. 2006, 20:547-54.
Leonard M, Mokotedi L, Alao U, Glynn A, Dolan M, Fleming P. The use of locking plates in proximal humeral fractures: Comparison of outcome by patient age and fracture pattern. Int J Shoulder Surg. 2009;3(4):85–9
Panagiotopoulou VC, Varga P, Richards RG, Gueorguiev B, Giannoudis PV. Late screw-related complications in locking plating of proximal humerus fractures: A systematic review. Injury. 2019;50(12):2176–95. Epub 2019 Nov 6 PMID: 31727401.
Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011;42(4):408–13. Epub 2010 Dec 19 PMID: 21176833.
Sudkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, et al. Open reduction and internal fixation of proximal humerus fractures with use of locking proximal humerus plate. Results of a prospective, multicentre, observational study. J Bone Joint Surg Am. 2009;91(6):1320–28. doi: 10.2106/JBJS.H.00006.
Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21(3):185–91. doi: 10.1097/BOT.0b013e3180333094.
Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humerus fractures corrected. J Bone Joint Surg Am. 2008;90(2):01–06. doi: 10.2106/JBJS.F.01351.
Roderer G, Erhardt J, Graf M, Kinzl L, Gebhard F. Clinical results for minimally invasive locked plating of proximal humerus fractures. J Orthop Trauma. 2010;24(7):400–06. doi: 10.1097/BOT.0b013e3181ccafb3.
Vijayvargiya M, Pathak A, Gaur S. Outcome analysis of locking plate fixation in proximal humerus fracture. Journal of Clinical and Diagnostic Research. 2016;10(8):R01–R05. doi: 10.7860/JCDR/2016/18122.8281.
Published
Issue
Section
License
Copyright (c) 2025 Diamond Tamunokuro, Orupabo Furo, Ayoko Utavie
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Journal is owned, published and copyrighted by the Nigerian Medical Association, River state Branch. The copyright of papers published are vested in the journal and the publisher. In line with our open access policy and the Creative Commons Attribution License policy authors are allowed to share their work with an acknowledgement of the work's authorship and initial publication in this journal.
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author.
The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
TNHJ also supports open access archiving of articles published in the journal after three months of publication. Authors are permitted and encouraged to post their work online (e.g, in institutional repositories or on their website) within the stated period, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). All requests for permission for open access archiving outside this period should be sent to the editor via email to editor@tnhjph.com.
