Can the Inverted Application of the PHILOS Plate Be an Alternative in Extra-articular Distal Humerus Fractures? A Comparative Analysis with the Extra-articular Distal Humerus Plate

Abstract

Backgroud: The Proximal Humeral Internal Locking System (PHILOS) plate, designed for the treatment of proximal humeral fractures, demonstrates versatility when used in an inverted (upside-down) configuration. We aimed to retrospectively compare the clinical and radiographic outcomes of patients who underwent surgical treatment for extra-articular diaphyseal distal humeral fractures using either an extra-articular distal humerus plate (EADHP) or a modified PHILOS locking compression plate.

Methods: This study included 58 patients: 39 in the EADHP group (group A) and 19 in the PHILOS plate group (group B). Clinical outcomes were assessed using a visual analog scale for pain rating, the Mayo Elbow Performance Score, and range of motion measurements. Radiological evaluation was performed using anteroposterior, lateral, and oblique views of the humerus. The presence of radial nerve symptoms was evaluated before and after surgery.

Results: Patients in group B exhibited substantially shorter average operation times (105.8 minutes) and less mean blood loss (250.0 mL) than those in group A with an average operation time of 123.3 minutes and mean blood loss of 456.4 mL. Furthermore, a higher incidence of hardware removal was observed in group A (23.1%) than in group B (15.8%), with the procedure typically occurring approximately 15 months postoperatively in both groups. However, no significant discrepancies were found in clinical outcomes between the 2 groups, including time to fracture union and radial nerve injury rates, with no statistically significant distinctions detected between them.

Conclusions: Application of the modified PHILOS plate demonstrated outcomes comparable to those of the EADHP in treating extra-articular diaphyseal distal humerus fractures, with significantly reduced operation time and blood loss.