scholarly journals PHILOS plate versus nonoperative treatment in 2-, 3-, and 4-part proximal humeral fractures: Comparison with healthy control subjects

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987516 ◽  
Author(s):  
Emrah Çaliskan ◽  
Özgür Doğan
Keyword(s):  
Proximal Humerus ◽  
Nonoperative Management ◽  
Functional Results ◽  
Nonoperative Treatment ◽  
Proximal Humerus Fractures ◽  
Control Subjects ◽  
Healthy Control ◽  
Vas Scores ◽  
Humerus Fractures ◽  
Nonoperative Group

Purpose: There is no consensus in the literature on nonoperative treatment of displaced and multipart fractures of proximal humerus as those are normally treated operatively. Our aim was to compare the functional results of nonoperative management and open reduction internal fixation with the proximal humerus internal locking system of 2-, 3-, and 4-part proximal humerus fractures, among themselves and with a healthy control group. Methods: Between 2014 and 2018, 92 proximal humerus fractures constituting a nonoperative group ( n = 47) and an operative group ( n = 45) together with healthy control subjects ( n = 45) were analyzed in a tertiary care referral center. The American Shoulder and Elbow Surgeons (ASES) shoulder score and visual analog scale (VAS) pain score were used for subjective functional analysis. Range of motion and muscle strength were analyzed objectively for all patients and healthy control subjects. Results: In 2-part fractures, VAS scores and hand grip strength were determined as lower in the nonoperative group ( p = 0.033 and p = 0.034, respectively). In 3- and 4-part fractures, there was no difference between the two groups in terms of ASES and VAS scores. Patients who underwent surgery had more muscle strength than those in the nonoperative group, but only arm extensor and forearm flexor muscle strengths were statistically significant for 3-part fractures. In cases of 4-part fractures, objective functional results were similar between the two groups. Conclusions: With insufficient functional results and high complication rates in surgery, nonoperative management is still the preferred choice for proximal humerus fractures, especially in case of multipart fractures.

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

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

Nonoperative Treatment of Proximal Humerus Fractures: A Systematic Review

2011 ◽  
Vol 25 (10) ◽  
pp. 612-617 ◽  
Author(s):  
Jaicharan J Iyengar ◽  
Zlatko Devcic ◽  
Robert C Sproul ◽  
Brian T Feeley
Keyword(s):  
Systematic Review ◽  
Proximal Humerus ◽  
Nonoperative Treatment ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

scholarly journals A prospective study to evaluate functional results of PHILOS locking plate system in management of proximal humerus fractures in adults

2021 ◽  
Author(s):  
Satish R. Gawali ◽  
Venktesh D. Sonkawade ◽  
Pradeepkumar S. Nair ◽  
Gaurav B. Mate
Keyword(s):  
Locking Plate ◽  
Proximal Humerus ◽  
Functional Results ◽  
Functional Evaluation ◽  
Complication Rates ◽  
Proximal Humerus Fractures ◽  
Female Ratio ◽  
Humerus Fractures ◽  
Locking Plate System ◽  
Plate System

<p class="abstract"><strong>Background:</strong> Various management options are available for management of proximal humerus fractures where PHILOS plating is one of them. But data available in literature on its use and efficacy in management of all types of proximal humerus fractures is still dicey. So, we through our study attempted to grow our knowledge regarding its functional results, complication rates, etc. for use in coming future.</p><p class="abstract"><strong>Methods:</strong> 30 patients with proximal humerus fractures classified on the basis of Neer’s classification were included in study who were operated from 2018 to 2020 at our institute. These patients were operated by PHILOS locking plate system with either delto-pectoral or trans-deltoid approach and they are followed up at regular intervals to assess them clinicoradiologicallly and functionally by Neer’s criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study we found maximum incidence of these fracture between age group of 40-80 years (66.66%) with male to female ratio of 2:1 with 19 patients having left sided and 11 patients having right sided proximal humerus fracture. Complications were found in 11 patients (36.67%). Functional evaluation was carried out using Neer’s criteria at final follow up which came to excellent results in 3, satisfactory in 18, unsatisfactory in 7 and failure in 2 patients. Average time of fracture union was 12.62 weeks.</p><p class="abstract"><strong>Conclusions:</strong> PHILOS locking plate system serves good purpose in management of fractures of proximal humerus but requires trained faculty to do this operation who has detailed knowledge about shoulder anatomy and mechanism of injury to reduce complications associated with this type of modality.</p>

Analysis of Functional Outcomes in Inner Osteosynthesis for Proximal Humerus Fractures

2003 ◽  
Vol 10 (3) ◽  
pp. 62-66
Author(s):  
E Sh Lomtatidze ◽  
V E Lomtatidze ◽  
S V Potseluyko ◽  
E A Toropov ◽  
E Sh Lomtatidze ◽  
...  
Keyword(s):  
Shoulder Joint ◽  
Functional Outcomes ◽  
Proximal Humerus ◽  
Functional Results ◽  
Proximal Humerus Fractures ◽  
Muscular Force ◽  
Limb Function ◽  
Younger Patients ◽  
Humerus Fractures ◽  
With Screws

Between 1998 and 2002, 32 patients (11 males, 21 females), aged 26-78 years, with proximal humerus fractures were operated on. In 29 cases osseous osteosynthesis by AO technique with T- and L-shape plates and screws was performed, in 2 cases osteosynthesis was carried out using Kirshner wire and in 1 case with screws and wire. In all patients functional results were evaluated by American Shoulder and Elbow Surgeons system in terms from 7 to 48 months after operation. The following parameters were included: pain, movement range, muscular force, stability/instability of shoulder joint, limb function. In patients over 60 years movement range and limb function were reliably decreased compared to younger patients (p

scholarly journals Functional outcome of proximal humerus fracture treated with proximal humerus interlocking system plating

2019 ◽  
Vol 5 (5) ◽  
pp. 936
Author(s):  
Hemeshwar Harshwardhan ◽  
Buddhi Prakash Verma
Keyword(s):  
Proximal Humerus ◽  
Functional Results ◽  
Bony Union ◽  
Proximal Humerus Fractures ◽  
Excellent Outcome ◽  
Medical College ◽  
Satisfactory Outcome ◽  
Philos Plate ◽  
Humerus Fractures ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> Proximal humerus fractures account for 4-5% of all fractures. They are the commonest fractures in elderly population, which ranks the third, after hip and distal radius fractures respectively. Displaced fractures treated by pinning, cancellous screws, intra-medullary nails, proximal humeral plates and hemiarthroplasty. The proximal humerus interlocking system (PHILOS) plate is anatomically contoured and the threaded screw heads are locked into the threaded plate holes which allow early rehabilitation. The aim of this study is to evaluate results and complication of PHILOS.</p><p class="abstract"><strong>Methods:</strong> This a prospective study, conducted at JLN Medical College, Ajmer from 1st January 2017 to 31st July 2018. 36 patients of displaced proximal humerus fractures were included and operated at hospital with PHILOS plating. We evaluate Intra-operative events, post-operative radiological evaluations and bony union by NEER’S score and complications.<strong></strong></p><p class="abstract"><strong>Results:</strong> Functional results according to NEER’S score were found that out of 36 patients, 11 patients (30.5%) had excellent outcome, 19 patients (52.7%) have satisfactory outcome, 3 patients (8.33%) had unsatisfactory outcome and 3 patients (8.33%) had poor outcome.</p><p class="abstract"><strong>Conclusions:</strong> Internal fixation of proximal humerus fractures with use of PHILOS yields reliable results when utilized correctly. To achieve gold standard results, early physiotherapy is must which can only be done by stable fixation, ORIF with PHILOS provides more stable construct with anatomical reduction.</p>

Proximal Humerus Fractures

2018 ◽  
pp. 71-94
Author(s):  
Joaquin Sanchez-Sotelo
Keyword(s):  
Internal Fixation ◽  
Proximal Humerus ◽  
Nonoperative Treatment ◽  
Proximal Humerus Fractures ◽  
Imaging Studies ◽  
Residual Pain ◽  
Functional Loss ◽  
Orthopedic Surgeon ◽  
Technical Complications ◽  
Humerus Fractures

Fractures of the proximal humerus are common. A relatively large number of these injuries will heal with nonoperative treatment without major residual pain or functional loss. However, internal fixation or arthroplasty leads to a much better outcome for selected fractures. The orthopedic surgeon dealing with these injuries is faced with three challenges. First, it is difficult to understand these fractures based on imaging studies and to select those patents that will do better with surgery. Second, internal fixation and arthroplasty for proximal humerus fractures are difficult procedures and fraught with technical complications. And third, complications often require challenging salvage procedures.

scholarly journals Minimally invasive percutaneous plate osteosynthesis for the treatment of proximal humerus fractures in osteoporotic patients with Philos plate

2013 ◽  
Vol 12 (2) ◽  
pp. 140-145
Author(s):  
Ram Ji Lal Sahu
Keyword(s):  
Minimally Invasive ◽  
Proximal Humerus ◽  
Plate Osteosynthesis ◽  
Medical Science ◽  
Functional Results ◽  
Autogenous Bone ◽  
Proximal Humerus Fractures ◽  
Philos Plate ◽  
Humerus Fractures ◽  
A Prospective Study

Introduction: To investigate the effect of minimally invasive percutaneous plate osteosynthesis for treatment of proximal humerus fractures in osteoporotic patients with philos plate. Methods: A prospective study was conducted at Department of Orthopedics, M.M.Medical College, Mullana Ambala, from July 2005 to November 2010. A Total of 108 cases of proximal humerus fractures were treated with minimally invasive percutaneous plate osteosynthesis with philos plate. According to Neer classification, 89 cases had two part fractures, 19 had tree part fractures. Results: All the 108 cases were followed up ranging from 12 to 18 months with an average of 14 months. Radio graphically, union was observed in 92 patients at the end of 10 weeks. In 10 patients, times to union were 16 weeks. Six patients underwent autogenous bone grafting because of nonunion after 16 weeks. The mean Constant-Murley score was 86 (range 74-92). The functional results of the shoulder, according to Muley scores, were classified as excellent in 85.15% cases, good in 9.25% cases and fair in 5.55 cases. Conclusion: Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humerus fractures in osteoporotic patients with philos plate shows good results and less complication. Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13 Page 140-145 DOI: http://dx.doi.org/10.3329/bjms.v12i2.14941

scholarly journals High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review

2020 ◽  
Vol 11 ◽  
pp. 215145932097156
Author(s):  
Jordan M. Walters ◽  
Shahryar Ahmadi
Keyword(s):  
Bone Quality ◽  
Geriatric Patients ◽  
Proximal Humerus ◽  
Nonoperative Management ◽  
Total Shoulder Arthroplasty ◽  
Treatment Options ◽  
High Energy ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures ◽  
Trauma Teams

High-energy proximal humerus fractures in elderly patients can occur through a variety of mechanisms, with falls and MVCs being common mechanisms of injury in this age group. Even classically low-energy mechanisms can result in elevated ISS scores, which are associated with higher mortality in both falls and MVCs. These injuries result in proximal humerus fractures which are commonly communicated via Neer’s classification scheme. There are many treatment options in the armamentarium of the treating surgeon. Nonoperative management is widely supported by systematic review as compared to almost all other treatment methods. ORIF is particularly useful for complex patterns and fracture dislocations in healthy patients. Hemiarthroplasty can be of utility in patients with fracture patterns with high risk of AVN and poor bone quality risking screw cut-out. Reverse total shoulder arthroplasty is a popular method of treatment for geriatric patients also, with literature now showing that even late conversion from nonoperative management or ORIF to rTSA can lead to good clinical outcomes. Prevention is possible and important for geriatric patients. Optimizing medical care including hearing, vision, strength, and bone quality, in coordination with primary care and geriatricians, is of great importance in preventing fractures and decreasing injury when falls do occur. Involving geriatricians on dedicated trauma teams will also likely be of benefit.

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