Minimal Invasive Percutaneous Osteosynthesis for Elderly Valgus Impacted Proximal Humeral Fractures with the PHILOS

There is a growing concern about elderly valgus impacted proximal humeral fractures. The aim of this study was to evaluate the treatment and clinical outcomes following minimal invasive percutaneous plate osteosynthesis (MIPPO) with the proximal humeral internal locking system (PHILOS) for the treatment of elderly valgus impacted proximal humeral fracture. Between May 2008 and May 2012, 27 patients (average age 67.3, range 61–74) with valgus impacted proximal humeral fractures were enrolled in the study. The patients were treated with MIPPO using PHILOS-plate through the anterolateral delta-splitting approach. Rehabilitation exercises were done gradually. The NEER score and Constant-Murley score were used to evaluate shoulder function. All the patients were followed up by routine radiological imaging and clinical examination. There were 15 cases of II-part greater tuberosity fractures, 10 cases of III-part greater tuberosity fractures, and 2 cases of IV-part fractures according to the NEER classification. The surgery was successful in all patients with an average follow-up of 20.8 (range: 11–34) months. The fractures united in an average of 7.2 (6–14) weeks without implant loosening. According to NEER score, there were 17 excellent, 7 satisfactory, 2 unsatisfactory, and 1 poor. The mean Constant-Murley score was89.4±4.35. No complication including axillary nerve damage, postoperative nerve or vessel damage, infections, DVT, or death was observed. In conclusion, the MIPPO technique with the PHILOS through the anterolateral delta-splitting approach seems to be a safe and easy treatment for elderly valgus impacted proximal humeral fractures. A case-control study and longer follow-up time are needed.

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Plate Fixation for Irreducible Proximal Humeral Fractures in Children and Adolescents—A Single-Center Case Series of Six Patients

Children ◽

10.3390/children8080635 ◽

2021 ◽

Vol 8 (8) ◽

pp. 635

Author(s):

Florian Freislederer ◽

Susanne Bensler ◽

Thomas Specht ◽

Olaf Magerkurth ◽

Karim Eid

Keyword(s):

Closed Reduction ◽

Biceps Tendon ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Constant Murley Score ◽

Fractures In Children ◽

Initial Surgery ◽

Conjoint Tendon

Background: Recommended treatment for severely displaced proximal humeral fractures in children is the closed reduction and percutaneous fixation by K-wires or intramedullary nailing. Methods: From January 2016 to January 2017 6, 21 children/adolescents (range 8 to 16 years) with proximal humeral fractures were treated surgically for severe displacement. In these six patients, several attempts of closed reduction were unsuccessful, and an open reduction was performed. The humeral head was fixed with a 3.5 mm T-plate without affecting the growth plate. Plate removal was performed at a mean interval of 132 days after initial surgery. Two years after initial surgery, the clinical outcome was assessed by the Constant–Murley score and QuickDASH score (including sport/music and work) and the shoulder joint was evaluated with a standardized sonographic examination for the rotator cuff and the conjoint tendon. Results: In all six patients, dorsal displacement of the fracture was irreducible due to the interposition of tendinous or osseous structures. Intraoperatively, the interposed structures were the long biceps tendon in two, periosteal tissue in two, a bony fragment in one, and the long biceps tendon together with the conjoint tendon in one case. At mean follow-up of 26 months (range 22 months to 29 months), patients showed very good clinical results with an excellent mean Constant–Murley score of 97.5 (range 91 to 100) and mean QuickDASH score (including sport/music and work) of 5.5 (range 0–20.8). An X-ray follow-up 6 weeks after surgery demonstrated early consolidation and correct alignment in all patients. A sonographic evaluation at 2 years post injury showed that the biceps and the conjoined tendon were intact in all patients. Conclusions: If a proximal humeral fracture is not reducible by closed means, a tissue entrapment (most likely biceps tendon) should be considered. Treatment with an open reduction and plate fixation yields very good clinical and radiological results and preserves interposed structures as the biceps and conjoint tendon.

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Stable osteosynthesis of cage in cage technique for surgical treatment of proximal humeral fractures

BMC Surgery ◽

10.1186/s12893-021-01235-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiantao Li ◽

Yuan Gao ◽

Caixia Yin ◽

Hao Zhang ◽

Shaobo Nie ◽

...

Keyword(s):

Mechanical Stability ◽

Humeral Fracture ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Dash Score ◽

Peek Cage ◽

Polyether Ether Ketone ◽

Stable Osteosynthesis ◽

Long Term Follow Up

Abstract Background The treatment of a displaced proximal humeral fracture is still a matter of controversy. The purpose of this study was to report outcomes at a long-term follow-up after fixation augmentation using peek (polyether-ether-ketone) cage and locking compression plate (LCP). Methods A total of 27 patients (average age 53.8 years, range 19–86 years) were treated with peek cage and LCP. All of them had a minimum radiographic and clinical follow-up of 1 years. Outcomes were assessed using the Constant-Murley score (CMS), disability of the arm, shoulder and hand (DASH) score. Complications were also recorded during follow-up. Results The average follow-up was 28 months (range 12–48 months). The mean functional outcomes were as follows: CMS, 73.3 (range 61–86); DASH, 45.9 (range 27–68). A total of 4 patients had complications: osteonecrosis developed in one patient, loss of reduction was observed in 1 patient and stiffness was occurred in two patients. Conclusion The use of peek cage and LCP has been a valuable option in the treatment of proximal humeral fractures. The complication rate was acceptable. Suitable void filler in the proximal humerus for reconstructing the medial column integrity attains mechanical stability in reducing the incidence of the complications.

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Clinical effect of using MultiLoc® nails to treat four-part proximal humeral fractures

Journal of International Medical Research ◽

10.1177/0300060520979212 ◽

2020 ◽

Vol 48 (12) ◽

pp. 030006052097921

Author(s):

Zhaofeng Jia ◽

Chuangli Li ◽

Jiandong Lin ◽

Qisong Liu ◽

Guangheng Li ◽

...

Keyword(s):

Fracture Healing ◽

Clinical Effect ◽

Operation Time ◽

Shoulder Function ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Fixation Method ◽

Vas Score ◽

Surgical Fixation

Objective This study was performed to evaluate the clinical effect of MultiLoc® nails (DePuy Synthes, Raynham, MA, USA) on the treatment of four-part proximal humeral fractures (PHFs). Methods From January 2014 to January 2018, 32 patients with four-part PHFs were treated with intramedullary MultiLoc® nails in our hospital. The operation time, bleeding volume, postoperative X-ray findings, and fracture healing status were recorded and analyzed. At the end of follow-up, the clinical outcome was evaluated based on the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant–Murley score (CMS), and occurrence of any complications. Results Among all patients, the average operation time was 124.5 minutes (range, 91–152 minutes), the average amount of bleeding was 90 mL (range, 55–150 mL), and the fracture healing rate was 100%. At the end of follow-up, the mean VAS score was 1.6 ± 0.4, mean ASES score was 84.4 ± 6.3, and mean CMS was 70.3 ± 6.1; no serious complications had occurred; and the patients exhibited good recovery of shoulder function. Conclusions MultiLoc nails® can be applied to the treatment of four-part PHFs. This surgical fixation method has no obvious complications and helps to restore shoulder function.

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Dual Locking Plate Osteosynthesis for 3- or 4-Part Proximal Humeral Fractures Combined with Multiple Fractures of the Greater Tuberosity

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00284-3 ◽

2020 ◽

Author(s):

Yongchuan Li ◽

Nan Lu ◽

Fan Zhang ◽

Zhibin Zhou ◽

Liangyu Zhao ◽

...

Keyword(s):

Locking Plate ◽

Plate Osteosynthesis ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Multiple Fractures ◽

Greater Tuberosity ◽

Locking Plate Osteosynthesis

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Low complication rates in Minimally Invasive Plate Osteosynthesis (MIPO) for proximal humeral fractures at 5 years of follow-up

Injury ◽

10.1016/j.injury.2019.01.042 ◽

2019 ◽

Vol 50 ◽

pp. S34-S39 ◽

Cited By ~ 2

Author(s):

F. Falez ◽

M. Papalia ◽

S. Carbone ◽

A. Teti ◽

F. Favetti ◽

...

Keyword(s):

Minimally Invasive ◽

Plate Osteosynthesis ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Minimally Invasive Plate Osteosynthesis ◽

Complication Rates

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Assessment of the restriction of arm elevation after intramedullary fixation for proximal humeral fractures

Shoulder & Elbow ◽

10.1177/1758573216687265 ◽

2017 ◽

Vol 9 (2) ◽

pp. 100-104 ◽

Cited By ~ 1

Author(s):

Hiroaki Inui ◽

Katsuya Nobuhara

Keyword(s):

Glenohumeral Joint ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Bony Union ◽

Greater Tuberosity ◽

Zero Position ◽

Maximum Elevation ◽

Entry Points ◽

Arm Elevation

Background Nail protrusion is suspected as a reason for the restriction of arm elevation after antegrade nailing of proximal humeral fractures, although assessment of the restriction of the glenohumeral joint during arm elevation has been insufficient. Methods In this retrospective study, 30 shoulders with proximal humeral fractures in 29 cases were treated with Polarus short nails (Acumed, Beaverton, OR, USA). At a mean final follow-up of 14 months, clinical outcomes, bony union, alignment including retroversion of the head and entry points of the nails were evaluated. The ability of a subject to achieve maximum elevation above the zero position was also evaluated. Results Constant and Japanese Shoulder Association scores were a mean (SD) of 54 (12) and 71 (8.9) points, respectively. Even though all cases achieved bony union without mal-alignment of the head and greater tuberosity height or protrusion of the nail at its entry point, only six subjects could achieve maximum elevation above the zero position. Conclusions Based on these findings, treatment of proximal humeral fractures with an antegrade humeral nail inserted from the top of the humeral head results in restricted arm elevation, even in patients without nail protrusion or fragment malalignment.

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Functional outcome in displaced proximal humeral fractures in adults treated by proximal humeral locking plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195813 ◽

2019 ◽

Vol 6 (1) ◽

pp. 178

Author(s):

N. V. Narasimha Rao ◽

K. Ravi Kanth ◽

Rama Priya Yasam ◽

T. Jaya Chandra

Keyword(s):

Functional Outcome ◽

Locking Plate ◽

Proximal Humerus ◽

Shoulder Function ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Medical College ◽

Score Improvement ◽

Average Improvement

Background: The management of proximal humerus fractures (PHF) is a challenging task to any surgeon. Study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system in fixation of displaced proximal humeral fractures.Methods: Study was conducted in the Department of Orthopedics, GSL Medical College. Informed written consent was taken from the study participants. All skeletally mature patients aged >18 years, presenting with displaced PHF according to Neer two, three and four part fracture were included in the study. Either deltopectoral or deltoid splitting approach was used for surgery, post-operative rehabilitation was started on day one.Results: Twenty-five patients with PHF were enrolled in the study; five-holed proximal humerus locking plate (PHLP) was used for 18 patients, eight-holed PHLP for 05 and three-holed, ten-holed PHLP for 01 for one each. The Constant-Murley score was significantly improved (p=0.000) over each successive follow-up period with the average improvement of around 19 scores between 1st and 2nd follow-up and around 15 score improvement between 2nd and 3rd follow-up.Conclusions: The proximal humeral locking plate is an adequate device for the fixation of displaced two-part, three-part and four-part PHF. Patient can regain good shoulder function, resume normal activities much earlier.

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Mid-term results after proximal humeral fractures following angular stable plate fixation in elderly patients—which scores can be evaluated by a telephone-based assessment?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1536-8 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Patrick Ziegler ◽

Kim Stierand ◽

Christian Bahrs ◽

Marc-Daniel Ahrend

Keyword(s):

Elderly Patients ◽

Constant Score ◽

Plate Fixation ◽

Humeral Fracture ◽

Weighted Kappa ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Cross Tabulation ◽

Mid Term Results

Abstract Background The aim was to evaluate postsurgical outcome in elderly patients (> 70 years) after open reduction and internal fixation (ORIF) of proximal humeral fractures and compare the test-retest agreement of scores which are frequently used to assess the outcome of upper extremity disorders. Methods Ninety patients (78.1 ± 5.2 years) with a minimum follow-up of 2 years (3.7 ± 0.9 years) following angular stable plate fixation of a proximal humeral fracture (2-part: 34, 3-part: 41, 4-part: 12) were enrolled. Two telephone-based interviews assessed Disabilities of the Arm, Shoulder and Hand Score (DASH), Oxford Shoulder Score (OSS), and Constant Score adjusted for interview assessment (CS) by two independent interviewers. Correlations, Bland-Altman analyses, Cross tabulation, and weighted Kappa measure of agreement (k) were calculated to assess differences and the test-retest agreement between the categories of each score. Results In the first and second interview, we could state fair outcomes: CS 91 (range 40–100) and 65.5 (23–86), DASH 12.5 (0–64.2) and 18.3 (0–66.7), and OSS 58 (33–60) and 55 (25–60) points. The test-retest correlations were r = 0.67, r = 0.77, and r = 0.71 for CS, DASH, and OSS. Bland-Altman analyses showed absolute mean individual score differences of − 22.3, 4.9, and − 3.0 for CS, DASH, and OSS. Limits of agreement represented possible differences of 21.6%, 15.5%, and 9.0% of CS, DASH, and OSS. The category agreements were medium to high: CS 55.9% (k = 0.08), DASH 87.2% (k = 0.62), and OSS 99.3% (k = 0.74). Conclusion Patients showed good subjective outcomes. The test-retest agreement of the interview-adjusted CS was low, but telephone-based assessment of OSS and DASH present as an alternative to collect outcomes in elderly patients. Trial registration (250/2011BO2).

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PROXIMAL HUMERAL FRACTURES TREATED WITH OSTEOSYNTHESIS USING THE ANTEROLATERAL APPROACH

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192703218226 ◽

2019 ◽

Vol 27 (3) ◽

pp. 173-177

Author(s):

Guilherme Grisi Mouraria ◽

Américo Zoppi Filho ◽

Fernando Kenji Kikuta ◽

Lucas Moratelli ◽

Paulo Pedroso Silveira Junior ◽

...

Keyword(s):

Retrospective Study ◽

Functional Results ◽

Contralateral Side ◽

Shoulder Function ◽

Axillary Nerve ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Anterolateral Approach ◽

Level Of Evidence ◽

Main Complication

ABSTRACT Objective: The main surgical approach in proximal humeral fractures is the deltopectoral approach. Many surgeons avoid the anterolateral approach, fearing its complications, especially axillary nerve injury. The objective of this study is to evaluate shoulder function and complications in patients with proximal humeral fractures treated using an anterolateral approach with direct observation of the axillary nerve. Methods: Retrospective study with postoperative radiological and functional evaluations (Constant and DASH scores) and review of the complications. The associations between fracture classification and the difference in Constant scores among the subjects and the final angle of consolidation were analyzed using Fisher's test or analysis of variance (ANOVA). The Constant scores were compared among the shoulders using the paired t-test. Results: The study evaluated 35 patients. Shoulder function was decreased, compared with the contralateral side (p<0.005). The only factor related to functional worsening was the Neer IV fracture. The main complication was malunion. There were no clinical changes related to the axillary nerve. Conclusion: The treatment using the extended anterolateral approach produced good functional results, although the function was decreased (Neer IV fractures). The main complication was malunion. There were no side effects due to exposure of the axillary nerve. Level of evidence III, Retrospective Study.

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