PHILOS Plate Plus Oblique Insertion of Autologous Fibula for 2-Part Proximal Humerus Fractures With Medial Column Disruption: A Retrospective Study

Introduction: The aim of this retrospective study was to evaluate the outcomes of older patients with 2-part proximal humerus fractures (PHFs) with medial column disruption stabilized using a proximal humeral internal locking system (PHILOS) plate plus oblique insertion of autologous fibula as a primary procedure. Materials and Methods: Data involving 112 patients (112 shoulders) sustaining 2-part PHFs with medial column disruption treated with PHILOS plate plus oblique insertion of autologous fibula as a primary procedure during 2012-2019 were identified. The median follow-up was 36 months (range: 11.2-43.5 months). The primary endpoint was the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores. The secondary endpoint was the main orthopedic complication rate. Results: The median Constant and ASES scores were 78 (range, 52-95) and 77 (range, 62-96) at the final follow-up, respectively. The main orthopedic complication rate was 10.7% (12/112). Twelve orthopedic complications in 8 patients were detected, and they involved loss of reduction, varus collapse, aseptic loosening, mal-union, revision, and intolerable shoulder pain. Of these complications, 3 (2.6%) involved loss of reduction, 2 (1.7%) involved varus collapse, 3 (2.6%) involved aseptic loosening, 1 (0.8%) involved mal-union, 2 (1.7%) required revision surgery, and 1 (0.8%) presented intolerable shoulder pain. Conclusion: PHILOS plate plus oblique insertion of autologous fibula as a primary procedure may yield good functional outcomes and a low rate of the main orthopedic complications.

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Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely – A Retrospective Study

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211050155 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110501

Author(s):

Huihui Cheng ◽

Jiali Yu ◽

Zhirui Dong ◽

Huanyi Lin ◽

Qilong Liu ◽

...

Keyword(s):

Elderly Patients ◽

Proximal Humerus ◽

Secondary Outcome ◽

Proximal Humerus Fractures ◽

Severe Osteoporosis ◽

Non Union ◽

Loss Of Reduction ◽

Philos Plate ◽

Humerus Fractures

Introduction To date, there is little research assessing the efficacy of a proximal humeral internal locking system (PHILOS) plate plus an allogeneic fibula inserted obliquely in the treatment of 2-part proximal humerus fractures (PHFs) with calcar comminution in patients >60 years old with severe osteoporosis. The aim of this study was to retrospectively evaluate the outcomes of elderly patients with osteoporotic 2-part PHFs combined with medial column (calcar) instability or disruption who experienced a PHILOS plate plus an allogeneic fibula inserted obliquely. Materials and Methods One hundred and twelve consecutive elderly patients with severe osteoporotic 2-part PHFs combined with calcar instability or disruption who were treated with a PHILOS plate plus an allogeneic fibula inserted obliquely were retrospectively identified from 3 tertiary medical centres during 2014–2019. The primary outcomes were the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores; secondary outcome was the rate of key orthopaedic complications. Results Median follow-up was 24 (15.3–27.6) months. Significant improvements in the median Constant scores were observed (39 [26–58 points] prior to surgery vs 81 [67–95 points] at final follow-up). The median ASES scores improved from 43 (26–64 points) prior to surgery to 83 (65–96 points) at final follow-up. The percentage of key orthopaedic complications was 25.6% (22/86). Four (4.7%) cases had loss of reduction, 4 (4.7%) experienced aseptic loosening, 1 (.8%) had non-union, 4 (4.7%) suffered a periprosthetic fracture, 3 (3.5%) experienced a revision surgery, 1 (.8%) had a dislocation and 5 (5.8%) suffered an unbearable shoulder pain. Conclusion For elderly patients with osteoporotic 2-part PHFs combined with calcar instability or disruption, PHILOS plate combined with an allogeneic fibula inserted obliquely might have recognisable advantages in decreasing the loss of fixation and preventing medial calcar collapse.

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Conversion to hemi-shoulder arthroplasty or reverse total shoulder arthroplasty after failed plate osteosynthesis of proximal humerus fractures: a retrospective study

Journal of International Medical Research ◽

10.1177/0300060520931241 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052093124

Author(s):

Xiulan Han ◽

Jintao Zhuang ◽

Weiguang Yu ◽

Yixin Gao ◽

Mingdong Zhao ◽

...

Keyword(s):

Retrospective Study ◽

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Total Shoulder Arthroplasty ◽

Proximal Humerus Fractures ◽

Major Complications ◽

Humerus Fractures ◽

Reverse Total Shoulder

Objective To assess the clinical outcomes of hemi-shoulder arthroplasty (HSA) versus reverse total shoulder arthroplasty (RTSA) following failed plate osteosynthesis of proximal humerus fractures in elderly patients. Methods This retrospective study identified all patients that had a documented failed plate osteosynthesis of proximal humeral fractures treated with revision HSA or RTSA. Follow-up occurred at 1, 3, 6 and 12 months after surgery and every year thereafter. The primary outcomes were the American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, visual analogue scale (VAS) pain scores and the University of California, Los Angeles Shoulder Rating Scale (UCLA SRS) scores. The secondary outcome was the rate of major complications. Results A total of 126 patients (126 shoulders) were enrolled in the study. At the final follow-up, the RTSA group had significantly greater improvements in ASES, SST and UCLA SRS scores than the HSA group. The RTSA group had significantly larger decreases in the VAS pain score compared with the HSA group. The rate of major complications was significantly higher in the HSA group than in the RTSA group (44.4% versus 27.5%, respectively). Conclusion RTSA provided superior functional outcomes compared with HSA, with a lower rate of major complications after a follow-up period of at least 5 years.

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Outcome of locking plate fixation for proximal humerus fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20160712 ◽

2016 ◽

Vol 2 (1) ◽

pp. 25

Author(s):

Neil Rohra ◽

Jimmy Chokshi ◽

Rishi Sanghavi

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Proximal Humerus ◽

Evaluation Criteria ◽

Proximal Humerus Fractures ◽

Age Group ◽

Philos Plate ◽

Humerus Fractures ◽

The Mean

Background: The objective of the study was to evaluate functional outcome of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.Methods: We reviewed 30 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2010 to 2015. There were 23 men and7 women with a mean age of 36 years (range 20-64).There were 22 patients in the age group of <60 years and 8 patients in the age group of >60 years. According to Neer classification system, 12, 11 and 4 patients had2-part, 3-part, and 4-part fractures, respectively and 2 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma center. Functional evaluation of the shoulder at final follow-up was done using Neer’s Evaluation Criteria.Results: The mean follow-up period was 20 months (range 14-40 months). All fractures united clinically and radio logically. The mean time for radiological union was 13.2 weeks (range 9-26 weeks).At the final follow-up the mean Neer’s Evaluation Criteria was 90 (range 76-100). The results were excellent in 17patients, Satisfactory in 8 patients, Unsatisfactory in 4 patients and Failure in 1 patient. During the follow-up, 3 cases of varus malunion, 1 case of failure of fixation were noted. No cases of AVN, hardware failure, locking screw loosening, infection or nonunion were noted.Conclusions: PHILOS provides stable fixation in proximal humerus fractures. In order to prevent the complications like avascular necrosis, knowledge of anatomy and vascular supply of head of humerus and good surgical dissection to preserve vascularity of humeral head is important.

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Bilateral Proximal Humerus Fracture – a Rare Combination with a High Complication Rate after Surgery

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0619-6400 ◽

2018 ◽

Vol 156 (06) ◽

pp. 646-652 ◽

Cited By ~ 1

Author(s):

Matthias Königshausen ◽

Valentin Rausch ◽

Eileen Mempel ◽

Alexander von Glinski ◽

Christopher Ull ◽

...

Keyword(s):

Complication Rate ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Humerus Fracture ◽

Proximal Humerus Fractures ◽

Loss Of Reduction ◽

Angle Stable ◽

Humerus Fractures ◽

Angle Stable Plate

Abstract Introduction Bilateral acute proximal humerus fractures are rare. There are no data available about these bilateral injuries. The aim of the study was to analyse bilateral proximal humerus fractures retrospectively in terms of incidence, complications and revisions. Methods All bilateral proximal humerus fractures were evaluated retrospectively using the institutionʼs database, with the focus on cause of the injury, fracture severity and the clinical course compared to published information on monolateral proximal humerus fractures. Bilateral posterior dislocation fractures were excluded, because these fractures are a separate entity. Results Between 2005 and 2016, n = 17 patients were primarily treated within our hospital for an acute proximal humerus fracture on both sides (n = 12 female, n = 5 male, average age: 68 years; overall 34 proximal humerus fractures). The general trauma mechanism was a fall on both arms (82% [18% polytrauma]). There were 65% displaced 3-/4-part proximal humerus fractures. Angle-stable plate osteosynthesis was performed predominantly (64%), followed by fracture prosthesis (18%; tension wiring: 3%; non-operatively: 15%). Overall, n = 10 patients (59%) or n = 18 (53%) proximal humerus fractures developed a complication, primarily with loss of reduction or implant loosening (44%). In n = 14 (78%) of the complications further operations were necessary. Alcohol abuse was increasingly found in 29% of the cases within the bilateral patient cohort compared to patients with monolateral fractures. Conclusion Bilateral proximal humerus fractures are mainly associated with comminuted displaced fractures and a higher complication rate in comparison to monolateral fractures after surgical treatment.

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Analysis of surgical fixation of displaced proximal humerus fractures using PHILOS plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163509 ◽

2016 ◽

Vol 2 (4) ◽

pp. 245

Author(s):

Lalith Mohan Chodavarapu ◽

Sreekanth Kashayi Chowdojirao ◽

Avinash Gonu ◽

Chandrasekhar Patnala ◽

Vijay Krishna Chilakamarri

Keyword(s):

Proximal Humerus ◽

Dash Score ◽

Proximal Humerus Fractures ◽

Independent Observer ◽

Constant Murley Score ◽

Fracture Dislocations ◽

Philos Plate ◽

Humerus Fractures ◽

The Mean

Background: The treatment of displaced proximal humeral injuries still throws challenges in identifying variables to prognosticate the outcome and optimizing a good clinical result. This study attempts to analyze the functional outcome of surgery of such fractures with proximal humeral interlocking system (PHILOS) plate and evaluate variables which help in predicting the prognosis.Methods: This is a retrospective and prospective study of 30 patients with displaced proximal humerus fractures - 2 part, 3 part, 4 part and fracture dislocations according to Neer classification, surgically treated using PHILOS plate during 2011 and 2014. Evaluation of patients was done on follow-up by an independent observer for union by radiographs and functional assessment by Constant-Murley score and DASH (disabilities of the arm, shoulder and hand) score.Results: The mean age of the patients was 40.4 years (range 18-65). 83.3% of the patients were male. The mean follow-up was 18.9 months (4-36 months). The mean Constant-Murley score and the DASH score were 76 and 16 respectively at the last follow-up. Our analysis showed that the patient’s age, delay in surgery, and Neer’s classification influenced the prognosis of the fracture. Medial metaphyseal extension in the fracture or an intact medial neck showed a better outcome. Complications were seen in 5 patients. Avascular necrosis was seen in 3 patients.Conclusions: Osteosynthesis of displaced proximal humeral fractures with PHILOS plate provides a good outcome, with low complication rate. Patient’s age and the type of fracture based on Neer’s classification prognosticate the outcome.

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A STUDY ON FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES TREATED WITH PHILOS PLATING

10.36106/ijar/9300284 ◽

2021 ◽

pp. 5-7

Author(s):

M.V. Sudhakar ◽

R.Ashok kumar ◽

A. Deepak ◽

B.S.S.S. Venkateswarlu

Keyword(s):

Functional Outcome ◽

Proximal Humerus ◽

High Energy ◽

Proximal Humerus Fractures ◽

Non Union ◽

Constant Murley Score ◽

Philos Plate ◽

Humerus Fractures ◽

The Mean

Background: Proximal humerus fractures are common and debilitating injuries. These fractures have a dual age distribution occurring either in young people following high energy trauma Usually high energy trauma associated with dislocation or in those older than 60 years with low-velocity injuries like simple fall, especially in elderly patients is due to osteoporosis and deforming forces of muscle attached. Wide range of treatment modalities ranging from conservative management to reverse shoulder arthroplasty. The non-operative method gives good results in stable and minimally displaced fractures. Displaced humeral neck fractures used to be managed conservatively in the past, but these were complicated by loss of reduction, malunion, non-union, stiffness and ultimately poor functional outcome. We took up this study to assess the efcacy and functional outcome of P.H.I.L.O.S. plating in proximal humerus. Our objectives are to study the fracture pattern with the Neer's criteria, to reconstruct the proximal humerus fracture anatomically with Philos plate, allow early shoulder mobilization and assessing the functional outcome using Constant Murley score. It is an Materials and methods: observational study of 30 patients (18 females and 12 males) with proximal humerus fractures that attended to the Department of Orthopaedics, Government General Hospital, Rangaraya medical college, Kakinada from December 2018 to December 2020. The mean follow-up Results: period was 12 months. Two patients lost follow-up. Of the remaining 28 patients, all fractures were united clinically and radiologically. At the nal follow-up the mean Constant-Murley score was 69.2 (range 50 -100). The results were excellent in 3, good in 12, fair in 10 patients, poor in 3 patients. During the follow-up 4 cases had varus mal-union, 5 had stiffness of the shoulder, 2 had supercial infection and1 had screw penetration. No cases of hardware failure, locking screw loosening or non-union were noted. T Conclusion: he divergent and convergent orientation of the locking screws of PHILOS plate provides stable biological xation with good radiological union. It minimises the soft tissue dissection and gives both axial and angular stability hence, reducing the risk of fracture displacement.

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Factors Influencing Functional Outcome of Philos Plate Fixation for Proximal Humerus Fractures

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v16i1.1147 ◽

2017 ◽

Vol 16 (1) ◽

Author(s):

Hazwan Ab. Wahid ◽

Khairul Nizam Siron ◽

Ahmad Zakiran

Keyword(s):

Functional Outcome ◽

Proximal Humerus ◽

Constant Score ◽

Plate Fixation ◽

Impingement Syndrome ◽

Proximal Humerus Fractures ◽

X Rays ◽

Philos Plate ◽

Humerus Fractures

Introduction: Displaced and unstable proximal humerus fractures are difficult to treat and they have high morbidity. The main goal is to achieve painless shoulder with full recovery of the shoulder joint motion. Impingement syndrome is one of the commonest postoperative complication. This study aim is to appreciate the functional outcomes of Philos-plate fixation for proximal humerus fractures and to establish association with high plate positioning with impingement syndrome of the shoulder after Philos-plate fixation. Materials and method: This is a retrospective study, reviewing 26 patients who had proximal humeral fractures and underwent open reduction and Philos-plate fixation between December 2010 and January 2015 in Hospital Tengku Ampuan Afzan, Kuantan. Preoperative X-rays or CT scans were inspected, follow-up visits and X-ray images were obtained at every follow-up to evaluate the plate position and bone union. Assessments of impingement syndrome and other complications were done and also functional outcome measured with Constant shoulder scoring system during final follow-up. Results: Almost 70% of patients achieved good (Constant score: 71-85) to excellence (Constant score: 86-100) outcome, with 77.54 mean Constant score. All cases achieved union. None of the cases developed complications like malunion, infection, AVN, and loosening of implant while 2 cases complicated with shoulder impingement post operatively. Among all the factors, age more than 60 years, and high plate position found to be a significant factor in the outcome of the surgery where both factors yielded significantly less mean Constant scores. Neer 3 parts fractures have higher mean of Constant score compare to Neer 4 parts fractures and high plate position is significantly associated with impingement syndrome postoperatively. Conclusion: This study showed that age, fracture type and plate position were key factors affecting shoulder function after Philos locking plate fixation surgery. We recommend that plate should be position at most 10mm from the greater tubercle to prevent impingement syndrome postoperatively and for better functional outcome.

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Prediction of radiological measurements of proximal humerus fractures treated with PHILOS plate using a prognostic multiplication factor

MedPulse International Journal of Orthopedics ◽

10.26611/10201521 ◽

2020 ◽

Vol 15 (2) ◽

pp. 09-13

Author(s):

Charles Abraham ◽

Keyword(s):

Proximal Humerus ◽

Proximal Humerus Fractures ◽

Multiplication Factor ◽

Radiological Measurements ◽

Philos Plate ◽

Humerus Fractures

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A Comparative Study of Open Reduction and Internal Fixation with PHILOS Plate versus Closed Reduction and Fixation with Percutaneous K Wiring of Neer’s 2-Part and 3-Part Proximal Humerus Fractures

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/466 ◽

2020 ◽

Vol 7 (40) ◽

pp. 2247-2250

Author(s):

Mahesh Gangaiah ◽

Monesh Kanakappa Basavaraj ◽

Balaraj Gowda Hanumantappa ◽

Girish Halasinanagenahalli Rudrappa ◽

Balakrishnan Honnapura Doppapettigama ◽

...

Keyword(s):

Comparative Study ◽

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Proximal Humerus ◽

Plate Versus ◽

Proximal Humerus Fractures ◽

Philos Plate ◽

Humerus Fractures

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Is serial radiological evaluation of one-part proximal humeral fractures necessary?

The Bone & Joint Journal ◽

10.1302/0301-620x.101b10.bjj-2019-0349.r1 ◽

2019 ◽

Vol 101-B (10) ◽

pp. 1307-1312

Author(s):

Matthijs Jacxsens ◽

Jeremias Schmid ◽

Vilijam Zdravkovic ◽

Bernhard Jost ◽

Christian Spross

Keyword(s):

Bone Quality ◽

Proximal Humerus ◽

Constant Score ◽

Nonoperative Treatment ◽

Proximal Humerus Fractures ◽

Radiological Evaluation ◽

Fracture Configuration ◽

Secondary Displacement ◽

Humerus Fractures

Aims In order to determine whether and for whom serial radiological evaluation is necessary in one-part proximal humerus fractures, we set out to describe the clinical history and predictors of secondary displacement in patients sustaining these injuries. Patients and Methods Between January 2014 and April 2016, all patients with an isolated, nonoperatively treated one-part proximal humerus fracture were prospectively followed up. Clinical and radiological evaluation took place at less than two, six, 12, and 52 weeks. Fracture configuration, bone quality, and comminution were determined on the initial radiographs. Fracture healing, secondary displacement, and treatment changes were recorded during follow-up. Results In 100 patients (59 female, 41 male; mean age 57 years), 91 of the fractures (91%) remained stable. In five of nine patients (55%) with secondary displacement, surgery was recommended. Comminution, present in 23 patients (23%), was identified as a predictor of secondary displacement (p < 0.001). Patients’ age, sex, fracture configuration, and bone quality were not associated with secondary displacement (p ≥ 0.438). Nonoperative treatment resulted in a mean absolute Constant score (CS) of 80 (49 to 98), relative CS of 101% (63% to 138%), median subjective shoulder value of 95% (interquartile range (IQR) 90% to 100%), and median EuroQol five-dimensional questionnaire score of 0.89 (IQR 0.80 to 1.00) with bone union in all cases at one-year follow-up. Conclusion Radiological re-evaluation was only necessary in patients presenting with comminution and may be redundant for 77% of patients with one-part proximal humerus fractures. Nonoperative treatment of one-part proximal humerus fractures remains the mainstay of treatment with a low rate of secondary surgery, a high union rate, and good clinical results. Cite this article: Bone Joint J 2019;101-B:1307–1312

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