A study of factors which influence the outcome in fracture dislocations of proximal humerus treated by open reduction and internal fixation with philos plate

Management of proximal humerus fracture dislocation is challenging owing to the possibility of multiple complications including avascular necrosis. Literature remains controversial regarding the mode of management Osteosynthesis vs arthroplasty and the pros and cons of one over the other, particularly in elderly age groups. This is a case series include 20 patients admitted with proximal humerus fracture dislocation and were treated with open reduction internal fixation with proximal humerus internal locking osteosynthesis systems (PHILOS) plate. Post operatively, serial X-rays were taken at post-operative day 1, 1 month, 6 months and at 1 year to assess the union. Clinically patients were assessed with constant Murley score at the end of 1 year. The mean constant-Murley score at the end of 1 year was found to be 70.8 with 86 being the highest and 42 being the least and it has a strong negative correlation with increasing age. 5% of the patients developed avascular necrosis and remaining 95% united well. The result also shows that the chances of occurrence of AVN humeral head is proportional to the duration of surgery since injury. We conclude that osteosynthesis for proximal humerus fracture dislocation gives good outcome including the elderly patients. Early fixation, anatomic reduction, meticulous placement of implant and minimal soft tissue stripping and adherence to appropriate and regular rehabilitation program can give better functional outcome irrespective of the age of the patient. The learning curve with the implant chosen and surgeon’s skill play a major role in the final outcome.