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 A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fu Wang ◽  
Yan Wang ◽  
Jinye Dong ◽  
Yu He ◽  
Lianxin Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Shoulder Joint ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Anterolateral Approach ◽  
Proximal Humerus Fractures ◽  
Locking Plate Fixation ◽  
Humerus Fractures

Abstract Background and hypothesis The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column. Materials and methods We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. Results There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred. Conclusions The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

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>

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>

scholarly journals A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

2020 ◽  
Author(s):  
Fu Wang ◽  
Yan Wang ◽  
Jinye Dong ◽  
Yu He ◽  
Lianxin Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Shoulder Joint ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Anterolateral Approach ◽  
Proximal Humerus Fractures ◽  
Locking Plate Fixation ◽  
Humerus Fractures

Abstract Background and hypothesis: The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column.Materials and Methods: An anatomical study was performed and an anatomical medial locking proximal humerus plate was designed based on the measurement results. Between November 2014 and April 2017, eight cases of proximal humerus fractures with unstable medial columns underwent medial fixation. All surgeries were performed by a single surgeon. Patients were followed clinically and radiographically at 1, 3, 6 and 12 months postoperatively.Results: There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10 degrees in any direction), screw cutout, nonunion, or deep infection occurred.Conclusions: The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.Level of evidence: Retrospective Study

scholarly journals Prospective observational study evaluating the outcome of a fixed angle plate (proximal humerus internal locking system) in proximal humerus fractures

2019 ◽  
Vol 6 (1) ◽  
pp. 117
Author(s):  
Kiran Ramachandran ◽  
Jackson Mathew ◽  
Praveen Koraboina ◽  
Ponnezhathu Sebastian John
Keyword(s):  
Functional Outcomes ◽  
Proximal Humerus ◽  
Osteoporotic Fractures ◽  
Attrition Rate ◽  
Proximal Humerus Fractures ◽  
Fixed Angle ◽  
Significant Difference ◽  
Humerus Fractures ◽  
Study Participants ◽  
Type Of Fracture

<p class="abstract"><strong>Background:</strong> Proximal humerus fractures are common among elderly. The present study assesses the functional outcomes of fixed angle plate (proximal humerus internal locking system (PHILOS)) in fractures of proximal humerus.</p><p class="abstract"><strong>Methods:</strong> 30 participants aged ≥18 years with proximal humerus fracture (2, 3 and 4 part) who underwent PHILOS fixation were enrolled. Undisplaced, open, severely comminuted, metastatic, and pathological fractures and with associated head injury and neurovascular injuries wew excluded. Clinical and radiological evaluation were done pre and post-operatively. Intraarticular extent of fracture geometry was assessed using 3-dimensional computed tomography. Participants were managed preoperatively with analgesics and shoulder immobilizer followed by preanesthetic check-up and routine investigations and surgery was done once participants were stable. Sample size was calculated assuming excellent or satisfactory results in 80% participants 6 months after surgery, relative precision of 20%, α of 5% and 10% attrition rate. Institutional ethics committee approved the study and written informed consent was obtained from all study participants.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean age of study participants was 62.9 (14.9) years and were predominantly females (66.6%, n=20). No significant difference between type of fracture and duration of recovery was observed (p=0.4). 30% participants had post-operative complications, stiffness was the most common (13.3%, n=4) complication. 76.6% (n=23) participants had good functional outcomes. Significant correlation between type of fracture and NEER score was observed (p&lt;0.0001).</p><p><strong>Conclusions:</strong> PHILOS is a preferential implant in proximal humerus fractures due to angular stability, particularly in comminuted fractures in younger patients, and osteoporotic fractures in elderly, thus allowing early mobilization and satisfactory final functional outcome. </p>

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 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.

Functional outcomes in proximal humerus fractures: a prospective registry-based analysis

2021 ◽  
pp. 1-6
Author(s):  
Tashfeen Ahmad ◽  
Zehra Abdul Muhammad ◽  
Amna Haroon
Keyword(s):  
Upper Limb ◽  
Functional Outcomes ◽  
Proximal Humerus ◽  
Care Hospital ◽  
Proximal Humerus Fractures ◽  
Treatment Groups ◽  
Significant Difference ◽  
Humerus Fractures ◽  
Limb Fractures ◽  
Upper Limb Fractures

Abstract Objective: To evaluate clinical and functional outcomes of proximal humerus fractures managed with different procedures and determining factors influencing outcomes. Methods: Data of this prospective cohort was obtained from the orthopaedic trauma registry at a tertiary care Hospital from June 2015 to October 2019. Sixty-nine adult patients with proximal humerus fracture managed either surgically or non-operatively were identified. Functional and clinical outcomes had been assessed using Quick Disability of the Arm, Shoulder and Hand score. Outcomes were assessed up to 12 months follow-ups and were compared between different treatment groups and between isolated versus proximal humerus with additional upper limb fractures. Results: In the 69 patients, 31 (45%) belonged to >55 years age group. Fifty-eight (84%) patients were operated of which 43 (62%) underwent Proximal Humeral Internal Locking System procedure. There was non-significant difference in clinical and functional outcomes between isolated versus proximal humerus fractures associated with other upper limb fractures at follow-ups 6 weeks onwards. At 3 months follow-up, there was significantly better outcomes in all treatment groups compared to PHILOS with bone graft/BMP (p=0.004-0.035). Males had significantly better recovery at 3 months as compared to females (p=0.04).  Continuous...

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