REVERSED PROXIMAL HUMERUS INTERNAL LOCKING SYSTEM (PHILOS) PLATE TECHNIQUE AS ALTERNATIVE OSTEOSYNTHESIS METHOD IN THE MANAGEMENT OF BIFOCAL MIDDLE AND DISTAL THIRD DIAPHYSEAL HUMERUS FRACTURE
Keywords:
Humeral shaft fracture, distal metaphyseal fracture, Reversed PHILOS plate tehnique, alternative osteosynthesis method.Abstract
Introduction: Humeral shaft fractures account for 2% of all fractures in adults with approximately 30% of them being located in the distal third. AO OTA 12.C2 type(s) fractures are rare injuries usually caused from high-energy trauma. Stable and rigid osteosynthesis is suggested with consequent early mobilization and rehabilitation protocol thus outweighing the conservative treatment complication rates, particularly elbow contracture. Multiple implants, approaches and techniques have been published in the literature with reversed (upside-down) "Proximal Humerus Internal Locking System"(PHILOS) plate technique as a new and alternative osteosynthesis method, which is presented in this article.
Case report: A 37-year-old female patient was presented to our emergency department by the emergency medical services (EMS) after motor-vehicle collision (MVC) as unrestrained front passenger with right zygomatic arch, right maxillary, sphenoidal and ethmoidal sinus fractures, nasal bones fracture, bilateral lung contusions, open grade IIIA right patellar multifragmentary fracture as well as right bifocal middle and distal third diaphyseal humerus fractures. An urgent open reduction and internal fixation (ORIF) with cerclage wire technique of the open multifragmentary right patellar fracture grade IIIA according to Gustilo-Anderson classification was done, followed by ORIF of the right bifocal middle and distal third diaphyseal humerus fracture using reversed (upside-down) "Proximal Humerus Internal Locking System" (PHILOS) plate technique.
Conclusion: The reversed PHILOS plate technique in the management of middle and distal humeral extra-articular diaphyseal fractures is feasible and should be further investigated.
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