OPEN REDUCTION AND INTERNAL FIXATION OF PROXIMAL HUMERUS FRACTURES WITH PROXIMAL HUMERUS LOCKING PLATE

Background: Despite of conservative management for proximal humeral fractures, open reduction and internal fixation with proximal humeral locking plate has become the most frequent treatment for these fractures especially in elderly and osteoporotic population. Efforts have been made to improve the locking plate fixation technique and strengthen the fixation more resilient to head collapse, screws cut out, screw penetration and loss of fracture reduction. Methods: This was a cross sectional study conducted at Department of orthopaedic surgery Services Hospital Lahore after approval from the hospital ethical review board a total number of 30 patients with proximal humeral fractures having age between 40 - 75 years were treated at our institute with proximal humeral locking plate. There were Eight 2 – part, 15 with 3- part fractures and 7 with 4- part fractures. All these patients were followed at interval of 3 weeks, 6 weeks, 3 months, 6 months and at one year. Results: In all 30 patients, fracture united 3(10.0%) months after the surgery. In 05 (16.7%), patients there were screw penetration in the shoulder joint. In these 05(16.7%), patients , 3(10.0%) patients developed avascular necrosis( AVN) and underwent shoulder arthroplasty. Loss of reduction was present in 04 (13.3%) patients in whom the revision surgery was done with addition of bone graft. Range of movements were significantly less in patients with 4- part fracture( forward elevation was 95 degree and head shaft angle was 100 degree in these patients while external rotation was 22 to 30), in rest of 25(83.3%)  patients it was within the normal range. Mean DASH score at baseline was 74.02+ 8.04, after 6 weeks was 58.4 + 3.38 while after one year at the end of final follow up it was 48.6 + 13.32. ( p = .000) (Table no:1) Conclusion: PHILOS fixation technique is an acceptable stabilization procedure for proximal humeral fractures especially in 3- part and 4- part fractures in osteoprotic bone. But at the same time it has got high complication rate like screw penetration in the joint, loss of fracture reduction and varus malunion etc.