PHILOS Plating: Outcome and Complications In Humerus Fracture Fixation

Arsalan Khalil Ayoub, Badaruddin Sahito, Dileep Kumar, Nusrat Rasheed, Sunel Kumar, Maratib Ali

Abstract

Objective

To assess the use, union rate and complications with proximal humerus interlocking osteosynthesis (PHILOS).

Study design

Descriptive study.

Place & Duration of study

Department of Orthopaedic surgery, Dow University of Health Sciences / Dr Ruth K M Pfau Civil Hospital Karachi, from January 2018 to February 2020.

Methodology

Patients with proximal humerus fracture Neer II, III, IV and with fracture dislocation,  proximal humerus nonunion and tumor were included in the study .  Type I, neglected proximal humerus fractures were excluded.

Results

Twenty-one patients were included in the study with age of 18 years - 65 years and mean age of 45 year. There were 12 (57.14%) male and 9 (42.85%) female patients. Ten (47.6%) patients had history of road traffic accident, 8 (38%) had fall and 3 (14.2%) with tumor. Ten (47.6%) were  with type III Neer and two (10%) type IV, type II noted in two (10%) patients, tumor in three (14%), two (10%) with fracture dislocation, one (5%) with proximal humerus and ipsilateral shaft fracture, one (5%) patient with nonunion humerus. Three (14.2%) patients had hypertension. In nine (42.8%) patients fracture united in 15 weeks, in six (28.4%) in 14 weeks, in three (14.2%) in 16 weeks and one united in 13 weeks. One patient with pathological fracture had bone cementation with PHILOS plate and other had plate after recycled bone re-implantation. Osteotomy site united in 13 weeks. One patient had curettage and bone cement fixed with PHILOS. Complications noted included screw out of bone in one (5%) patients, varus deformity in  four (21%), reduction problem in one (5%), impingement in one (5%), stiffness in three (14.2%), two of them having varus as well, and infection in one (5%) patient. A patient died of tumor. Maximum follow-up was of 15 months and minimum seven months.

Conclusions

Proximal humerus interlocking osteosynthesis is excellent implant with variable angle in plate for screws to be placed in multiple directions that provides good bone purchase. With this it provides good union rate. Complications were also noted in number of patients.

Key words

PHILOS, Proximal humerus fracture, Bone union, Osteosynthesis.