Correlation of Radiological Parameters with Functional Outcomes in Proximal Humeral Fractures Treated with PHILOS Plates: A Retrospective Analysis.

Abstract

Introduction: Proximal humerus fractures are prevalent, especially among the elderly, and pose significant challenges in treatment, particularly for displaced fractures. Despite the availability of various surgical techniques, outcomes remain inconsistent, often due to poor anatomical reduction and fixation. This study examines the correlation between specific radiographic parameters and functional outcomes, aiming to identify key predictors of recovery. By focusing on these parameters, we aim to refine surgical approaches and improve follow-up strategies, ultimately enhancing patient outcomes.

Materials and methods: A retrospective study involved 40 patients aged 18-75 with proximal humerus fractures, treated with open reduction and plate fixation at Chettinad Hospital between April 2022 and April 2024. All surgeries were performed through anterior deltopectoral approach. Radiographic parameters were evaluated postoperatively, with patients followed for a period of 1 year. Functional outcomes were correlated with radiological parameters using follow-up radiographs and Constant-Murley (C-M) scores.

Results: In this study of 40 patients with proximal humerus fractures, the mean age was 53.24 years, and the majority (60%) were male. The fractures predominantly affected the right side (62.5%), with road traffic accidents and falls being the leading causes. Neer's classification identified 10 patients with two-part fractures, 21 with three-part fractures, and 9 with four-part fractures. The average neck-shaft angle (NSA) was 138.62° ± 11.09°. Four patients with an NSA of ≤120° had fair to good functional outcomes, while those with an NSA >130° and a well-positioned greater tuberosity (GT) generally had better outcomes. The average distance between the GT and the acromion surface (AS) was 6 mm ± 1.4 mm, influencing shoulder abduction and functional results. Patients with an alpha/beta ratio below 1.40 mm, indicating lower bone density, had a higher incidence of screw cut-out. The mean C-M score at 6 months was 80.72, with 87.5% of patients achieving abduction above 90°. Complications occurred in 8 patients (20%), including varus collapse (10%), abduction <90° (12.5%), infection (2.5%), and screw cut-out (5%). Larger head diameters and heights were associated with better functional scores.

Conclusion: Radiographic parameters such as the NSA, GT to AS distance, head diameter, head height, and alpha/beta ratio are crucial predictors of functional outcomes in proximal humerus fractures treated with PHILOS plates. Accurate reduction and medial column stabilization are a key to minimizing complications and improving patient recovery. Despite generally positive outcomes, challenges such as screw cut-out and varus collapse persist, highlighting the need for meticulous surgical technique and thorough post-operative management.