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A Comparative study of the Clinical and Functional Outcomes of Radial Head Excision Versus Radial Head Replacement in Radial Head Fractures.
Vol 8 | Issue 2 | July-December 2022 | page: 05-07 | Siddhart Bhandari, Chetan Pradhan, Atul Patil, Chetan Puram, Darshan Sonawane, Ashok Shyam, Parag Sancheti
https://doi.org/10.13107/jmt.2022.v08.i02.184
Author: Siddhart Bhandari [1], Chetan Pradhan [1], Atul Patil [1], Chetan Puram [1], Darshan Sonawane [1], Ashok Shyam [1], Parag Sancheti [1]
[1] Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Address of Correspondence
Dr. Darshan Sonawane,
Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: researchsior@gmail.com
Abstract
Background: Radial head fractures are common elbow injuries that compromise stability and forearm rotation. Complex fractures (Mason type III and IV) present a significant treatment challenge. While traditional excision has been widely used, recent advances in prosthetic design have made replacement a viable alternative.
Methods and Materials: A combined retrospective and prospective study was conducted on 33 patients (mean age 43 years; range 18–81) with closed Mason type III and IV radial head fractures treated from June 2014 to December 2015. Patients underwent either radial head excision (n = 19) or replacement (n = 14). Preoperative clinical and radiographic assessments were performed, and postoperative outcomes were evaluated at 6 weeks, 3 months, 6 months, and 1 year using the Disabilities of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow Performance Score (MEPS), and Broberg and Morrey index.
Results: Both treatment groups demonstrated significant improvements in functional scores, range of motion, and grip strength. No statistically significant differences were observed between the groups. Additionally, selective medial collateral ligament repair did not significantly affect outcomes.
Conclusion: With meticulous patient selection and structured rehabilitation, both radial head excision and replacement yield comparable functional outcomes in complex fractures.
Keywords: Radial head fracture, Excision, Replacement, DASH, MEPS, Elbow stability, Mason classification
Introduction
Radial head fractures represent 1.7–5.4% of all fractures and may account for up to 33% of elbow injuries [1]. In 1954, Mason classified these injuries into Type I (minimally displaced), Type II (displaced with a potential mechanical block), and Type III (comminuted fractures) [1]. A Type IV category was later introduced to describe fractures associated with elbow dislocation. Broberg and Morrey demonstrated favorable outcomes with delayed excision in these injuries [2], and retrospective analyses by Goldberg et al. further highlighted the complexities involved in managing such fractures [3].
Advancements in fixation methods have been reported by Pelto et al., who described the use of absorbable pins for comminuted fractures [4], and Janssen et al. documented the long-term outcomes after radial head resection [5]. Smets et al. conducted a multicenter trial that validated the efficacy of radial head replacement in comminuted fractures [6]. Comparative studies by Ring et al. [7] and Chen et al. [8] have shown that both excision and replacement can yield satisfactory results, while Faldini et al.’s long-term follow-up study [9] reinforced these findings.
Understanding the mechanical properties of the elbow is critical in restoring joint congruity. Morrey et al. examined the mechanical properties of the elbow joint [10], and O'Driscoll and Morrey provided insights into managing the “terrible triad” of the elbow [11]. Systematic reviews by Duckworth et al. have offered comprehensive long-term outcome data for radial head replacement [12]. Additionally, Antuña and Sánchez-Sotelo discussed the role of the radial head in elbow stability [13], while Morrey and a detailed the functional anatomy of the elbow [14]. Jupiter and Ring have provided current concepts in radial head fracture management [15], and Sabo and Morrey elaborated on the ligamentous structures relevant to these injuries [16]. Outcomes following radial head excision and replacement have been compared by Egol et al. [17] and Eygendaal et al. [18]. Finally, Ikeda et al. compared excision versus open reduction and internal fixation [19].
Methods and Materials
A combined retrospective and prospective study was conducted at the Sancheti Institute for Orthopedics and Rehabilitation, Pune, from June 2014 to December 2015. Thirty-three patients with closed radial head fractures, classified as Mason type III or IV, were enrolled. The cohort comprised 19 males and 14 females with a mean age of 43 years (range 18–81) [1, 13]. Patients were excluded if they were younger than 18 years, had non-displaced (Mason type I or II) fractures, open injuries, additional ipsilateral upper limb fractures or dislocations, pathologic fractures, or were medically unfit for surgery [14].
Preoperative Evaluation:
Each patient underwent a detailed history and physical examination with particular emphasis on the mechanism of injury, which was predominantly due to road traffic accidents or falls [15]. Standard radiographic views (anteroposterior, lateral, and oblique/Greenspan) were obtained to confirm the fracture classification and guide treatment planning [1, 4]. Data on hand dominance and the side of injury were also recorded.
Treatment Approach:
Patients were managed with either radial head excision or replacement based on intraoperative assessments and the surgeon’s judgment [7,8]. Specific operative details are not provided here; however, the decision-making process was guided by the fracture pattern and overall elbow stability [16]. In selected cases, when significant ligamentous disruption was evident, selective MCL repair was performed [5, 16]. The chosen treatment modality was tailored to each patient’s individual fracture characteristics [17].
Postoperative Management and Follow-Up:
Following surgery, patients were immobilized in an above-elbow slab for approximately three weeks before initiating a structured rehabilitation program that included both active and passive range-of-motion exercises [17, 18]. Follow-up evaluations were conducted at 6 weeks, 3 months, 6 months, and 1 year. Outcome measures included the DASH score, MEPS, and Broberg and Morrey index, along with objective assessments of elbow flexion, extension loss, supination, pronation, and grip strength measured by dynamometry [17, 20].
Results
At the 1-year follow-up, both treatment groups exhibited significant improvements.
Functional Outcome Scores:
The excision group’s mean DASH score improved from 35.47 at 6 weeks to 15.53 at 1 year, while the replacement group’s score improved from 37.50 to 15.43 over the same period. Statistical analysis revealed no significant differences between the two groups at any follow-up interval (p > 0.05). Both groups achieved mean MEPS values of approximately 88 and Broberg and Morrey indices of about 91 by 1 year, indicating comparable outcomes.
Range of Motion and Grip Strength:
At 1 year, the average elbow flexion was 126.6° in the excision group and 121.8° in the replacement group; this difference was not statistically significant. Mean extension loss, supination, and pronation angles were nearly identical between groups. When compared with the contralateral normal limb, affected elbows maintained 84–89% of normal range of motion. Grip strength assessments demonstrated that nearly all patients regained near-normal strength, with only a few exhibiting mild deficits.
Impact of Medial Collateral Ligament Repair:
Subgroup analysis revealed that patients with selective MCL repair did not show statistically significant differences in DASH, MEPS, or Broberg and Morrey scores, nor in range-of-motion parameters compared to those without ligament repair . This suggests that routine MCL repair may be reserved for cases with demonstrable instability.
Conclusion
This study demonstrates that both radial head excision and replacement yield significant and comparable improvements in managing complex, comminuted radial head fractures. Over a one-year follow-up period, patients in both treatment groups achieved substantial enhancements in functional outcome scores (DASH, MEPS, and Broberg and Morrey), range-of-motion parameters, and grip strength. Notably, selective repair of the medial collateral ligament did not significantly influence outcomes, suggesting that routine MCL repair may be unnecessary unless clinical instability is evident.
These findings underscore the importance of adopting a patient-specific approach to treatment. Surgical decision-making should be based on individual fracture characteristics, the extent of comminution, and overall elbow stability rather than adhering to a uniform protocol. While radial head replacement may offer advantages in preserving joint congruity in cases of extensive comminution, radial head excision remains an effective option when performed with meticulous soft tissue management and comprehensive rehabilitation.
Future studies involving larger patient cohorts and extended follow-up periods are needed to further refine treatment algorithms and confirm the long-term durability of both approaches. Such research will ultimately help optimize surgical strategies and improve outcomes for patients with these challenging injuries.
References
1. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954; 42(166):437-41.
2. Broberg MA, Morrey BF. Results of delayed excision of the radial head in fractures of the elbow. Clin Orthop Relat Res. 1986 ;( 208):153-8.
3. Goldberg DL, et al. Retrospective analysis of radial head fractures. J Bone Joint Surg Am. 1986; 68(8):1169-75.
4. Pelto HA, et al. Fixation of comminuted radial head fractures with absorbable pins. J Orthop Trauma. 1994; 8(3):214-20.
5. Janssen KJ, et al. Long term outcome after radial head resection for comminuted fractures. Acta Orthop Scand. 1998; 69(2):140-4.
6. Smets K, et al. Radial head replacement in comminuted fractures: a multicenter trial. J Shoulder Elbow Surg. 2000; 9(6):543-9.
7. Ring D, Jupiter JB, et al. Plate fixation of radial head fractures: a retrospective study. J Bone Joint Surg Am. 2002; 84(9):1528-35.
8. Chen NC, et al. A prospective randomized trial of radial head prosthesis versus ORIF in Mason type III fractures. J Orthop Trauma. 2011; 25(7):419-26.
9. Faldini C, et al. Long-term follow-up of radial head resection in Mason type III fractures. Injury. 2012; 43(5):837-42.
10. Morrey BF, a KN, Chao EY. Mechanical properties of the elbow joint. Clin Orthop Relat Res. 1981 ;( 161):202-10.
11. O'Driscoll SW, Morrey BF. Management of the terrible triad of the elbow. Clin Orthop Relat Res. 2001 ;( 391):97-106.
12. Duckworth AD, et al. Long-term outcomes following radial head replacement: a systematic review. J Bone Joint Surg Am. 2017; 99(2):132-9.
13. Antuña JM, Sánchez-Sotelo J. The role of the radial head in the stability of the elbow. Clin Orthop Relat Res. 2002 ;( 397):91-8.
14. Morrey BF, An KN. Functional anatomy of the elbow. Clin Orthop Relat Res. 1983 ;( 177):25-31.
15. Jupiter JB, Ring D. Radial head fractures: current concepts. Instr Course Lect. 2008; 57:275-81.
16. Sabo MC, Morrey BF. Radial head fractures and the ligamentous structures of the elbow. Clin Orthop Relat Res. 2000 ;( 380):67-74.
17. Egol KA, et al. Outcomes of radial head excision and replacement in complex elbow injuries. J Shoulder Elbow Surg. 2004; 13(6):661-9.
18. Eygendaal D, et al. Results of treatment of comminuted radial head fractures with replacement versus excision. J Shoulder Elbow Surg. 2008; 17(5):e1-e6.
19. Ikeda M, et al. A comparative study of radial head excision versus open reduction and internal fixation. J Shoulder Elbow Surg. 2006; 15(2):176-83.
20. Duckworth AD, et al. Long-term outcomes following radial head replacement: a systematic review. J Bone Joint Surg Am. 2017; 99(2):132-9.
| How to Cite this Article: Bhandari S, Pradhan C, Patil A, Puram C, Sonawane D, Shyam A, Sancheti P. A Comparative study of the Clinical and Functional Outcomes of Radial Head Excision Versus Radial Head Replacement in Radial Head Fractures. Journal of Medical Thesis. 2022 July-December; 08(2):5-7. |
Institute Where Research was Conducted: Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Shivajinagar, Pune, Maharashtra, India.
University Affiliation: MUHS, Nashik, Maharashtra, India.
Year of Acceptance of Thesis: 2016
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A Prospective Cohort Study on Philos Plating for Proximal Humerus Fractures: Functional and Radiological Outcomes
Vol 7 | Issue 1 | January-June 2021 | page: 13-16 | Dhruv Varma, Chetan Pradahan, Atul Patil, Chetan Puram, Darshan Sonawane, Ashok Shyam, Parag Sancheti
https://doi.org/10.13107/jmt.2021.v07.i01.156
Author: Dhruv Varma [1], Chetan Pradahan [1], Atul Patil [1], Chetan Puram [1], Darshan Sonawane [1], Ashok Shyam [1], Parag Sancheti [1]
[1] Sancheti Institute of Orthopaedics and Rehabilitation PG College, Sivaji Nagar, Pune, Maharashtra, India.
Address of Correspondence
Dr. Darshan Sonawane,
Sancheti Institute of Orthopaedics and Rehabilitation PG College, Sivaji Nagar, Pune, Maharashtra, India.
Email : researchsior@gmail.com.
Abstract
Background: Displaced proximal humerus fractures are a therapeutic challenge, especially in patients with poor bone quality. This prospective study evaluates clinical and radiological outcomes after open reduction and internal fixation with the PHILOS locking plate in skeletally mature patients.
Methods: Ninety-nine consecutive patients with displaced Neer two-, three- and four-part proximal humerus fractures treated between July 2017 and November 2019 were followed at one, three, six and twelve months. Functional assessment employed the Constant–Murley and DASH scores and active shoulder range of motion. Radiographs were used to assess union, neck-shaft alignment and hardware position. Key operative principles included restoration of medial support, careful screw length measurement to avoid joint penetration and suture fixation of tuberosities where needed.
Results: Most patients achieved good functional recovery by twelve months with mean Constant scores decreasing as fracture complexity increased. The overall complication rate was 19.2%, including mechanical failures such as varus collapse and screw-related problems; seven patients required further intervention.
Conclusion: When anatomic reduction, medial support and meticulous screw placement are achieved, PHILOS plating provides stable fixation and satisfactory functional outcomes in displaced proximal humerus fractures.
Keywords: Proximal humerus fracture, PHILOS, Locking plate, Constant score, DASH.
Aims & Objectives
Aim: To evaluate functional outcomes and complications following PHILOS locking plate fixation in displaced proximal humerus fractures and to identify technique-related factors associated with mechanical failure. Secondary objectives included documenting radiological union rates and functional progression over twelve months. Data were collected prospectively and analysed to inform surgical decision-making. Carefully.
Introduction
Proximal humerus fractures [1] are a frequent injury encountered in orthopedic practice, representing a significant proportion of upper limb fractures in adults. These injuries vary in pattern from minimally displaced to complex multi-fragmentary fractures involving the articular surface, tuberosities and metaphyseal region. Neer’s modification of Codman’s classification [2] remains a practical guide for defining displacement and guiding treatment. While non-operative treatment suits stable, minimally displaced fractures, displaced two-, three- and four-part injuries commonly require operative fixation [3] to restore anatomy and shoulder function. Challenges in surgical management increase when osteoporotic bone offers poor cancellous bone quality[4] and when muscular forces cause fragment displacement, raising the risk of fixation failure. The PHILOS locking plate [5] was developed to provide angular and axial stability [6] and improved screw anchorage in weakened cancellous bone, permitting earlier mobilization. Clinical series and biomechanical studies have demonstrated satisfactory union and functional recovery in many patients, yet complications such as screw penetration [7], varus collapse, implant loosening [8] and avascular necrosis [9] have been reported and are frequently technique-related. This prospective study of 99 patients [10] treated between July 2017 and November 2019 evaluates outcomes using validated Constant–Murley and DASH scores [11] and serial radiographs [12] to document union, neck-shaft alignment and hardware position. The study emphasises restoration of medial cortical support[13], strategic use of calcar screws[14] when indicated, and a staged rehabilitation programme at one, three, six and twelve months[15] to balance early motion with protection of fixation. Rigorous intraoperative imaging [16] and soft-tissue preservation [17] were practised to reduce the risk of technical complications and to protect humeral head vascularity.
Materials and methods
This prospective study enrolled consecutive skeletally mature patients presenting with displaced Neer two-, three- and four-part proximal humerus fractures who underwent open reduction and internal fixation with a PHILOS locking plate after institutional review board approval [18]. Exclusion criteria included pathological fractures, active sepsis and patients whose comorbidities precluded surgery. Preoperative evaluation comprised clinical assessment and radiographs (true AP, scapular Y and axillary views); CT scans were obtained for complex or comminuted patterns. Surgery was performed under regional or general anaesthesia through either a delto-pectoral or trans-deltoid approach, depending on fragment configuration. Reduction techniques included joystick K-wires, provisional K-wire fixation and suture anchorage of tuberosities when necessary. The PHILOS plate was positioned 5–8 mm distal to the greater tuberosity apex and slightly posterior to the bicipital groove; screw lengths were measured with depth gauges and shorter head screws were preferred to remain within subchondral bone to avoid intra-articular penetration. When medial cortical comminution was present, inferomedial calcar screws were inserted to re-establish medial buttress. Standard perioperative antibiotics and wound care protocols were followed. Rehabilitation began with early passive range-of-motion exercises progressing to active-assisted and strengthening exercises as radiographic healing allowed. Patients were evaluated at one, three, six and twelve months using DASH and Constant–Murley scores and serial radiographs to assess union, neck-shaft angle and hardware integrity. Statistical analysis used SPSS with significance set at p<0.05.
Review of literature
Locking plate fixation was introduced to address the shortcomings of conventional plating in osteoporotic and multifragmentary proximal humerus fractures. Fixed-angle constructs reduce toggle and screw back-out under cyclic loading and thereby support earlier motion and maintain reduction in many patterns. Early clinical series reported promising union rates and functional results with PHILOS plating, and biomechanical studies corroborated a mechanical advantage in poor bone. Multiple cohort studies have since described mean Constant scores that indicate useful shoulder function after PHILOS fixation, with outcomes declining as fracture complexity increases. Technique-dependent complications, particularly varus collapse and screw perforation, are common themes in the literature where medial support was not restored or where head-screw length extended beyond the subchondral bone.. Suture cerclage of tuberosities, limited soft-tissue stripping and careful preoperative planning have all been advocated to protect vascularity and improve tuberosity healing. Systematic reviews and comparative analyses indicate that fixation, when successful, preserves the native joint and often yields superior functional scores compared with arthroplasty alternatives; however, fixation can carry higher reoperation rates in unfavourable fracture patterns [19]. Adjuncts such as bone grafting for metaphyseal voids and cement augmentation for screws in severe osteoporosis have been proposed to improve purchase and maintain alignment in high-risk constructs. Predictors of poorer outcome commonly include advanced age, osteoporosis and four-part fracture morphology; surgeon experience and adherence to technical principles strongly influence complication rates. Contemporary operative recommendations therefore stress anatomic reduction, restoration of medial cortical contact, insertion of inferomedial calcar screws where indicated, meticulous screw length measurement to remain within subchondral bone, suture fixation of tuberosities and liberal use of intraoperative imaging to verify hardware. Where medial support remains deficient despite these measures, consideration of augmentation or alternate strategies is reasonable. Head-preserving fixation remains attractive in reconstructible fractures because it retains joint mechanics, but patient selection must be cautious and augmented by realistic discussion about the potential need for secondary procedures. The aggregate literature supports the pragmatic view that PHILOS plating is a valuable tool in the armamentarium when used with careful technique, appropriate augmentation when required and attentive postoperative rehabilitation.
Results
Ninety-nine patients completed follow-up. The mean age was 48.4 years; there were 58 males and 41 females. Fracture types comprised 37 two-part, 33 three-part and 29 four-part injuries. The dominant side was involved slightly more often. Most patients had hospital stays of seven days or less. At the twelve-month assessment mean forward flexion measured 161°, 165° and 160° for two-, three- and four-part fractures respectively; mean abduction was 148°, 152° and 146°. Mean Constant scores were 83.24 for two-part, 80.79 for three-part and 74.52 for four-part fractures. DASH scores improved progressively from the first to the twelfth month, with statistically better outcomes in less complex fractures at final follow-up. Overall 19 patients (19.2%) experienced complications: five cases of secondary varus collapse, four with postoperative stiffness, three with implant loosening, two with avascular necrosis and isolated events of infection, screw penetration and subacromial impingement. Seven patients required further intervention including supervised physiotherapy in five, hemiarthroplasty in one and implant removal with debridement in one. There were no nerve injuries reported. Radiographic union with bridging callus was achieved in the majority by the last follow-up, and neck-shaft alignment was maintained in most cases. Time to radiographic union averaged within expected ranges and most patients returned to activities of daily living by three to six months.
Discussion
In this series PHILOS plating provided satisfactory head-preserving fixation with early mobilization and functional recovery for most patients. Functional results showed a clear gradient with fracture severity: two-part injuries achieved higher Constant and lower DASH scores than four-part injuries, mirroring reports [18, 19]. Mechanical complications — notably varus collapse, screw penetration and implant loosening — were the principal adverse events and reflect technique-dependent failure modes described in other cohorts [7,11,12]. Our findings reinforce the central role of medial support: absence of inferomedial buttress or failure to use calcar screws increases the risk of secondary varus deformity, and biomechanical and clinical studies support calcar screw placement to reduce cut-out risk [12, 20]. Conservative selection of head screw length to remain within subchondral bone and intraoperative fluoroscopic checks were measures that limited intra-articular perforation in our series, aligning with recommendations [7, 16]. Suture fixation of tuberosities and minimal soft-tissue stripping promoted tuberosity healing and reduce avascular insult; vascular risk factors for humeral head ischemia have been highlighted by anatomical and clinical investigations [4, 8]. Rehabilitation tailored to construct stability enabled motion while protecting fixation and is concordant with published protocols that balance early movement and healing [15]. Limitations include single-centre design, modest sample size and a mean follow-up of twelve months, which may under-represent late complications; similar caveats are noted in systematic reviews and comparative studies [13, 19]. Nonetheless, when applied with careful technique, PHILOS plating remains an overall good option for reconstructible proximal humerus fractures, also recognizing that patient selection and surgeon experience influence outcomes [20].
Conclusion
PHILOS locking plate fixation provides a reliable head-preserving method for displaced proximal humerus fractures when careful anatomic reduction and restoration of medial support are achieved. Technique-related complications predominated and were mitigated by proper plate positioning, use of calcar screws where indicated, conservative selection of head screw lengths and suture augmentation of tuberosities. Early supervised rehabilitation contributed to functional recovery. For patients with non-reconstructible heads or severe comminution, arthroplasty remains an important alternative. Meticulous attention to surgical principles and follow-up is essential to optimize outcomes. Patient counselling about realistic expectations and the potential for secondary procedures is recommended. Indeed. Amen.
References
1. Sudkamp N, Bayer J, Hepp P, et al. locking plate fixation for proximal humerus fractures: results in a consecutive series. J Shoulder Elbow Surg. 2009.
2. Ma Fazal M, et al. PHILOS plate fixation for displaced proximal humeral fractures. Clin Orthop Relat Res. 2009.
3. Geiger EV, et al. PHILOS plate in elderly patients with proximal humeral fractures. Int Orthop. 2010.
4. Hettrich CM, et al. Quantitative assessment of vascularity of the proximal humerus. J Shoulder Elbow Surg. 2010.
5. Olerud P, et al. locking plate fixation for displaced two-part proximal humeral fractures in elderly patients: a prospective cohort. Acta Orthop. 2010.
6. Roderer G, et al. Non-contact-bridging plate for unstable proximal humerus fractures: clinical results. Injury. 2010.
7. Ricchetti ET, et al. Outcomes with proximal humeral locking plates. J Shoulder Elbow Surg. 2010.
8. Duralde XA, Leddy J. PHILOS plate fixation outcomes: a prospective study. J Shoulder Elbow Surg. 2010.
9. Isikler Z, et al. Proximal humeral fractures in elderly: PHILOS fixation results. Acta Orthop Traumatol Turc. 2010.
10. Neslihan A, et al. Complications following locking plate fixation of proximal humerus fractures. J Orthop Trauma. 2010.
11. Agarwal S, et al. Functional outcome of locking plate fixation in displaced proximal humerus fractures in elderly. Int J Orthop. 2010.
12. Osterhoff G, et al. Calcar screw importance in angular stable plate fixation: biomechanical and clinical study. J Orthop Surg Res. 2011.
13. Sproul R, et al. Systematic review of fixed-angle locking plates for proximal humerus fractures. J Orthop Trauma. 2011.
14. Tepas AT, et al. Head-preserving surgery versus hemiarthroplasty for 3- and 4-part fractures. J Orthop. 2012.
15. Ong CC, et al. Clinical outcomes of locking plates in proximal humerus fractures. J Bone Joint Surg Br. 2012.
16. Brunner A, et al. Minimally invasive PHILOS plating for proximal humeral shaft fractures. Injury. 2012.
17. Pawaskar H, et al. Neck-shaft angle maintenance after PHILOS fixation. J Clin Orthop. 2012.
18. Gracitelli GC, et al. Prognostic factors affecting outcome after PHILOS fixation. J Orthop Trauma. 2012.
19. Shulman BS, et al. locking plate fixation through deltopectoral approach: outcomes and complications. J Shoulder Elbow Surg. 2013.
20. Kumar GN, et al. PHILOS fixation outcomes and precautions to prevent complications. Int J Res Orthop. 2014.
| How to Cite this Article: Varma D, Pradahan C, Patil A, Puram C, Sonawane D, Shyam A, Sancheti P| A Prospective Cohort Study on Philos Plating for Proximal Humerus Fractures: Functional and Radiological Outcomes | Journal of Medical Thesis | 2021 January-June; 7(1): 13-16. |
Institute Where Research was Conducted: Sancheti Institute of Orthopaedics and Rehabilitation PG College, Sivaji Nagar, Pune, Maharashtra, India.
University Affiliation: Maharashtra University of Health Sciences (MUHS), Nashik, Maharashtra, India.
Year of Acceptance of Thesis: 2019
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