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

Background: 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.Methods: 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.Results: 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<0.0001).Conclusions: 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.

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

Journal of the Pakistan Medical Association ◽

10.47391/jpma.04-600 ◽

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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Does plate-screw density affect the functional outcomes in the treatment of proximal humerus fractures?

Turkish Journal of Trauma and Emergency Surgery ◽

10.14744/tjtes.2021.99078 ◽

2021 ◽

Author(s):

Alkan Bayrak

Keyword(s):

Functional Outcomes ◽

Proximal Humerus ◽

Proximal Humerus Fractures ◽

Screw Density ◽

Humerus Fractures

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Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00606-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Alejandro Garcia-Reza ◽

Diego Matias Dominguez-Prado ◽

Constantino Iglesias-Nuñez ◽

Lucia Alvarez-Alvarez ◽

Beatriz Hernandez-Gonzalez ◽

...

Keyword(s):

Surgical Treatment ◽

Conservative Treatment ◽

Proximal Humerus ◽

Cox Regression ◽

Survival Rates ◽

Osteoporotic Fractures ◽

Fundamental Parameter ◽

Proximal Humerus Fractures ◽

Level Of Evidence ◽

Humerus Fractures

Abstract Background Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures. Material and methods We collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer’s exact tests and Student’s t-tests to compare the variables. We used the Kaplan–Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality. Results Patients with a CCI greater than 5 showed greater mortality (HR = 3.83; p < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR = 3.64; p < 0.001) than those with a CCI under 5. Conclusions Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient’s comorbidities should be a fundamental parameter when planning the therapeutic strategy. Level of evidence Level 3.

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Biomechanical comparison of screw-based zones of a spatial subchondral support plate for proximal humerus fractures

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411919827984 ◽

2019 ◽

Vol 233 (3) ◽

pp. 372-382

Author(s):

Ali Jabran ◽

Chris Peach ◽

Zhenmin Zou ◽

Lei Ren

Keyword(s):

Proximal Humerus ◽

Fracture Site ◽

Bending Stiffness ◽

Humeral Shaft ◽

Proximal Humerus Fractures ◽

Fixed Angle ◽

Varus Displacement ◽

Humerus Fractures ◽

Biomechanical Comparison ◽

Proximal Screw

Stabilisation of proximal humerus fractures remains a surgical challenge. Spatial subchondral support (S3) plate promises to overcome common complications associated with conventional proximal humerus plates. This study compared the biomechanical performance of S3 plate with a fixed-angle hybrid blade (Equinoxe Fx) plate and a conventional fixed-angle locking plate (PHILOS). The effects of removal of different S3 plate screws on the humeral stability were also investigated. A total of 20 synthetic left humeri were osteotomised transversely at the surgical neck to simulate a two-part fracture and were each treated with an S3 plate. Head screws were divided into three zones based on their distance from the fracture site. Specimens were divided into four equal groups where one group acted as a control with all screws and three groups had one of the screw zones missing. With humeral head fixed, humeral shaft was first displaced 5 mm in extension, flexion, valgus and varus direction (elastic testing) and then until 30 mm varus displacement (plastic testing). Load–displacement data were recorded to determine construct stiffness in elastic tests and assess specimens’ varus stability under plastic testing. Removal of the screw nearest to the fracture site led to a 20.71% drop in mean elastic varus bending stiffness. Removal of the two inferomedial screw above it resulted in a larger drop. The proximal screw pair had the largest contribution to extension and flexion bending stiffness. Varus stiffness of S3 plate constructs was higher than PHILOS and Fx plate constructs. Stability of humeri treated with S3 plate depends on screws’ number, orientation and location. Varus stiffness of S3 plate construct (10.54 N/mm) was higher than that of PHILOS (6.61 N/mm) and Fx (7.59 N/mm) plate constructs. We attribute this to S3 plates’ thicker cross section, the 135° inclination of its screws with respect to the humeral shaft and the availability of pegs for subchondral support.

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mocowanie implantu, zrost kostny, polyetheretherketone (PEEK), powłoka tytanowa

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.3458 ◽

2020 ◽

Vol 22 (4) ◽

pp. 223-232

Author(s):

Amr Abouelela ◽

Islam Mubark ◽

Ahmed Nagi ◽

Ahmed Genena

Keyword(s):

Functional Outcomes ◽

Proximal Humerus ◽

Radial Nerve Palsy ◽

Superficial Infection ◽

Significant Difference ◽

Operative Complications ◽

Final Score ◽

Humerus Fractures ◽

The Mean ◽

Shoulder Score

Background. This study examined the clinical outcomes of fixation of displaced fractures of the proximal humerus using a trans-deltoid approach. Material and methods. Twenty patients (13 male and 7 female) were treated with this technique, with a mean age of the patients of 38.85 years (range, 19 to 64 years). All patients were followed up for at least twelve months and were evaluated according to the Constant shoulder score. Results. The mean Constant Shoulder score was 87.45, ranging from 63 to 100. Ten patients (50%) had excellent results, four patients (20%) had good results, three patients (15%) had satisfactory results, and three had adequate results (15%). There was a statistically significant difference between the type of the fracture and the final score (p=0.013), where 3-part fractures with impaction (11-B1), either valgus or varus impaction, showed higher scores than those without impaction. Four patients presented with post-operative complications varying from superficial infection to radial nerve palsy. Conclusions. 1. The trans-deltoid approach was a safe and reliable alternative to the delta-pectoral approach for the treatment of displaced proximal humerus fractures. 2. The impacted (11-B1) fracture type was a significant contributing factor in terms of good functional outcomes.

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Influence of Radiographic Bone Quality on the Type of Proximal Humerus Fracture

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.8136 ◽

2021 ◽

Vol 23 (2) ◽

pp. 65-77

Author(s):

Aleksandra Koczy-Baron ◽

Bogdan Koczy ◽

Michał Mielnik ◽

Tomasz Stołtny ◽

Kamil Baczyński ◽

...

Keyword(s):

Bone Quality ◽

Proximal Humerus ◽

Proximal Humerus Fractures ◽

Bone Thickness ◽

X Ray ◽

Local Bone ◽

Humerus Fractures ◽

Type 3 ◽

The Relationship ◽

Type Of Fracture

Background. The risk of proximal humerus fractures increases with age and deterioration of bone quality over time, and the treatment of these injuries may be clinically challenging.The aim of this study was to analyse the relationship between local bone quality and the morphology of proximal humerus fractures. Material and methods. We conducted a retrospective study of 187 patients diagnosed with proximal humerus fractures. X-ray images of all patients were analysed, and on this basis, bone quality was assessed, using the Deltoid Tuberosity Index (DTI), average cortical bone thickness (CBTavg) and the Tingart measurement. The type of fracture was classified according to Neer’s and Association for Osteosynthesis (AO) classifications. Moreover, the caput-collum-diaphyseal (CCD) angle was measured and the relationships between valgus or varus fractures and the DTI, CBTAVG and Tingart parameters were investigated in all patients. Results. Using the Neer classification, the most common fracture type was type 3, found in 90 patients (48.1%). A total of 51 patients (27.3%) sustained an AO B1 fracture. Significantly lower mean DTI values were noted in patients with a Neer 4 fracture compared to those with Neer 3 (p = 0.02) and Neer 2 fractures (p = 0.03). Moreover, significantly higher mean DTI (p <0.00) and CBTAVG (p <0.025) values were noted in the group of patients with valgus fractures (CCD> 140º). Conclusions. 1. In the group of patients diagnosed with a four-part fracture according to Neer, bone quality assessed using the Deltoid Tuberosity Index was significantly worse than in two- and three-part fractures. 2. Significantly higher bone quality, assessed on the basis of the DTI and CBTAVG indices, was observed among patients with valgus fractures compared to those with varus fractures.

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Analysis of Functional Outcomes in Inner Osteosynthesis for Proximal Humerus Fractures

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto200310362-66 ◽

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

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Anatomic placement of shoulder prosthesis for complex proximal humerus fractures: A modified method for hemiarthroplasty

10.21203/rs.3.rs-24174/v1 ◽

2020 ◽

Author(s):

Wanfu Wei ◽

Jian'an Li ◽

Guoyun Bu ◽

Tao Yang

Keyword(s):

Linear Regression ◽

Blood Loss ◽

Proximal Humerus ◽

Operation Time ◽

Shoulder Prosthesis ◽

Proximal Humerus Fractures ◽

Treatment Groups ◽

Constant Murley Score ◽

Significant Difference ◽

Humerus Fractures

Abstract BackgroundThe placement of shoulder prosthesis used for reconstruction of a complex proximal humerus fractures is challenging. To achieve the anatomical placement of prosthesis, we introduced a new operative technique to determine the humerus height and humeral head retroversion. Herein, we retrospectively investigated the clinical and radiographic outcomes of our procedure.Method34 patients, treated by shoulder arthroplasty for 4-part or 3–part proximal humeral fracture during the period between June 2016 and December 2018, were enrolled in the study. Eventually 29 patients, 18 women and 11 men with an average age of 68.4 years (range 58–85 years), were followed up successfully. Of which 13 patients treated with classic method were matched to 19 of the 29 new method treated patients by operation time, blood loss, pain, range of motion, Constant-Murley score and radiologic features.ResultsThere was significant difference between the two treatment groups in operation time (p = 0.024), while there was no significant difference in blood loss (p = 0.078). No significant difference was found between the two treatment groups in Visual Analog scale (p = 0.225), Constant-Murley score (p = 0.930), and radiological outcomes (p = 0.504). There was linear regression and correlation between Constant-Murley score and age (p = 0.027), while there was no linear relationship between status of tuberosity and the function of the shoulder joint (p = 0.931).ConclusionWe introduce a new operative technique to determine the humerus height and humeral head retroversion for shoulder arthroplasty operation. Based on the data, there is linear regression and correlation between Constant-Murley score and age, while there is no linear relationship between status of tuberosity and the function of the shoulder joint. Our present analyses reveal that our protocol is personalized, easy, effective and feasible.Trial registration: https://doi.org/10.1186/ISRCTN28175069.

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