Assessment of the outcome of fracture proximal humerus transdeltoid versus deltopectoral approach with PHILOS

Introduction: Fracture proximal humerus accounts for 4 percent of all fractures. Out of all the humerus fractures, proximal fractures accounts for 26%. According to the Neer’s classification, 2, 3- and 4-part fracture are difficult to achieve stable fixation. In this study, we want to assess whether the different surgical approach, deltopectoral and transdeltoid approach, used for the stabilization of the fracture proximal humerus effects on the outcome of the surgery.Method: A total of 30 patients with fracture proximal humerus 2, 3 and 4-part were included in this study and were divided into 2 groups. In group 1, 15 patients were taken and were operated by deltopectoral approach, while in group 2, 15 patients were taken and operated by transdeltoid approach. All the fixation was done by PHILOS.Result: In group 1, out of 3 patients having 2-part fracture, 2 had excellent result and 1 had fair result. Out of 4 patients having 3-part fracture, 3 had good outcome and 1 had fair result. Out of 6 patients having 4-part fracture, 1 had good outcome. In group 2, out of the 3 patients having 2-part fracture, 1 had excellent outcome and 2 had good outcome. Out of the 4 patients having 3-part fracture, 1 had excellent outcome, 3 had good outcome. Out of the 6 patients having 4-part fracture, 3 had good result.Conclusions: Deltopectoral approach is recommended for calcar reconstruction that provides better visibility of medial calcar reduction while transdeltoid approach is recommended for greater tuberosity reduction that provides better visibility of greater tuberosity.

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Use of proximal humerus internal locking system plate in proximal humerus fractures and its relation with the functional outcome

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195799 ◽

2019 ◽

Vol 6 (1) ◽

pp. 90

Author(s):

Prasanna Kumar G. S. ◽

Akash V. Mane ◽

Amit Kumar Yadav ◽

Abhishek Harsoor ◽

Jithsen Manna

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Proximal Humerus ◽

Constant Score ◽

Tertiary Care ◽

Care Hospital ◽

Proximal Humerus Fractures ◽

Excellent Outcome ◽

Good Outcome ◽

Humerus Fractures

Background: Proximal humerus fractures are the fractures occurs at or proximal to the surgical neck of the humerus, which accounts for 7% of all fractures and 80% of all humeral fractures. Now a days most of these fractures are managed with internal fixation because of better availability of anatomical plates. The aim was to assess the functional outcome and complications of proximal humerus fractures treated with proximal humerus internal locking system (PHILOS).Methods: This is a prospective study of 30 patients with two, three, and four parts proximal humerus fractures treated with proximal humerus internal locking sysyem from 2016 to 2018 with 25 to 80 years of age in a tertiary care hospital. Functional outcome is assessed by using constant murley shoulder scoring system.Results: Functional outcome as per constant score, 10 patients (33%) got excellent outcome, 06 patients (20%) got very good outcome, 07 patients got (23%) good outcome, 05 patients got (17%) fair outcome and 02 patients got (07%) poor outcome. Complications observed were superficial infections, implant failure and axillary nerve neuropraxia.Conclusions: Open reduction and internal fixation by using PHILOS is the ideal method in treating displaced proximal humerus fractures mainly in two and three part proximal humerus fractures which provides stable fixation and less complications.

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Outcome of Transformed FL(t-FL) Worsens According to the Timing of Transformation and to the Number of Previous Therapies. A Survey of the Fondazione Italiana Linfomi (FIL)

Blood ◽

10.1182/blood.v126.23.3933.3933 ◽

2015 ◽

Vol 126 (23) ◽

pp. 3933-3933

Author(s):

Chiara Rusconi ◽

Antonella Anastasia ◽

Annalisa Chiarenza ◽

Luigi Marcheselli ◽

Federica Cavallo ◽

...

Keyword(s):

B Cell Lymphoma ◽

Disease Stage ◽

High Dose ◽

Excellent Outcome ◽

Diagnosis Group ◽

Historical Series ◽

Treatment Naïve ◽

First Relapse ◽

Group 2 ◽

Group 1

Abstract Background: Histologic transformation (HT) refers to a biologic event leading to the development of a high grade non-Hodgkin lymphoma, mostly diffuse large B cell lymphoma (DLBCL), in patients (pts) with an underlying follicular lymphoma (FL), whose recently reported risk is 2% to 3% per year. The prognosis of t-FL has been considered historically very poor, but several studies in the Rituximab (RTX) era suggest that survival may be more favorable than previously recognized. The treatment approach for t-FL is often individualized and pts are generally excluded from clinical trials, so there is a paucity of objective data on the optimal management of t-FL, which still represents an unmet need. The aim of our survey conducted in a large number of pts with histologically confirmed t-FL observed in 9 FIL Centers was to analyze the clinical factors and the different treatment strategies which can predict post-transformation outcome. Methods: One hundred seventy-seven t-FL were retrospectively selected from Institutional datasets; the inclusion time frame was from 2002 to 2014. All Histologic Transformations (HT) were biopsy confirmed. Response assessment was made as recommended by International Workshop criteria. Survival analysis were performed with Kaplan-Meier method and compared by Log-Rank test. Results: T-FL occurred at initial diagnosis (Group 1) in 93 cases (53%): 52 were DLBCL (29%) evolving from a prior FL, 31 (17%) composite lymphoma and 10 (6%) discordant lymphoma. HT occurred after a previous FL diagnosis (Group 2) in 84 pts (47%): 15 pts (8%) were treatment-naïve at HT (Group 2A), 38 pts (21%) transformed at first relapse or progression (Group 2B) and 31 (18%) experienced late HT (Group 2C). Median age at HT was 60 years (range: 20-83). No differences were found between Group 1 and 2 and between Group 2A, 2B and 2C in term of clinical features (age, disease stage, B-symptoms). Group 1 received CHOP/CHOP-like regimens in 75% of pts. RTX was used with chemotherapy (CT) in 92% of pts and in 22% as maintenance. Autologous Stem Cell Transplantation (ASCT) was delivered as consolidation in 14%. Group 2 received CHOP/CHOP-like regimens in 39% of pts, platinum-containing regimens in 14%, high dose sequential therapy in 32%. RTX was added to CT in 71% of cases; 12% received RTX maintenance and 23% ASCT consolidation. CHOP as CT and RTX maintenance were used more often in Group 1 pts. Overall Response Rate (ORR) for Group 1 was 94%, with 77 pts (83%) achieving Complete Response (CR) and 10 (11%) Partial Response (PR).With a median follow-up of 43 months, 5-yr Progression-Free Survival (PFS) and Overall Survival (OS) were 60% and 83%, respectively. ORR for Group 2 was 57%, with 43 pts (51%) obtaining CR and 5 (6%) PR; focusing on the subgroups 2A, 2B, 2C ORR was 80%, 63% and 39%, respectively (p 0.017). The 5-yr OS was 52%, statistically inferior to Group 1 (p <0.001) (Figure 1). The use of RTX with CT and of consolidation ASCT favourably influenced survival only in group 2 but not in group 1 pts in univariate analysis. Survival showed a significant trend (p<0.001) to progressively worsen from Group 1 to Group2c pts (Figure 2). Moreover, considering the number of previous FL treatment lines received by group 2, 5-yr OS was 58% for pts who received 1-2 lines compared to 20% for pts who received > 2 lines (p=0.004) (Figure 3). Conclusion: Outcome of t-FL in the RTX era confirms to be better than reported in historical series and strongly differs among subgroups of pts according to the time of transformation and to the number of pre-HT treatment lines. Pts with FL transformation at lymphoma diagnosis, including composite and discordant cases, or with FL transforming after an initial watch and wait policy, i.e. treatment-naïve, show an excellent outcome with standard immuno-chemotherapy, comparable to that of FL (Federico JCO 2013) and of de novo DLBCL (Cunningham, Lancet Onc 2013). They probably do not benefit from front-line ASCT consolidation. Both ORR and survival are significantly worse in pts with t-FL diagnosed after being treated for FL. However t-FL diagnosed at first relapse/progression in this study obtained a 5-ys OS of 51%, which compares favorably with historical cohorts. On the other hand late transformation has an inferior outcome, which becomes really dismal in the sub-group of pts who transformed after two previous lines for FL, whose median survival is less than one year and clearly represent an unmet clinical need. Disclosures Rusconi: Roche: Honoraria.

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The effects of Kinesio Tape application with different verbal input given to with patients with rotator cuff tear

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00058 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0005

Author(s):

Yıldız Analay Akbaba ◽

Ebru Kaya Mutlu ◽

Süleyman Altun ◽

Gözde Gümüşoğlu ◽

Derya Çelik

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Effect Size ◽

Functional Limitations ◽

Excellent Result ◽

Kinesio Tape ◽

Cuff Tear ◽

Group 3 ◽

Group 2 ◽

Group 1

Purpose: Rototor cuff tears are most common of shoulder pain.and functional limitations. Kinesio tape (KT) are frequently used in the conservative treatment of shoulder pathology. Even if some studies showed that KT is effective on pain, we think that it is due to positive thoughts of the patients about KT. The aim of the study to investigate the effectiveness KT aplication with different verbal inputs on pain, function and range of motion (ROM) on patient with rotator cuff tear. Materials-Methods: 97 patients (Group 1, n=32; Group 2, n=33, Group 3, n=32) were randomized into 3 groups according to verbal input given to patients about the effectiveness of KT; Group 1 (it has been limited evidence of KT is effective), Group 2 (it has been not known that KT is effective or not), Group 3 (it has been known that KT has excellent result). The same standard KT was applied to 3 groups. The rest, night and pain in activity were assessed by VAS before, after 30 min and 24 hours after KT application. ROM assessed by goniometer and the function was evaluated by Disabilities of the Arm, Shoulder and Hand (DASH) and ASES before and 24 hours of KT application. Minimal clinically important difference and effective were calculated for the assessments used in the study. Results: Demographic variables were not different between groups. Resting pain did not change in Group 1 and Group 2 (pË‚0,05), however all pain parameters was significantly reduced in Group 3 (p = 0.001). Intra-group changes of ROM were not significant in all groups. DASH and ASES were significantly improved only Group 2 and 3. However, there were not significant different in terms of VAS, ROM, DASH and ASES among three groups (pËƒ0,05). The effect size was found in only positive verbal given group (Group 3) higher than the other groups, but the effect size was found very low. Conclusions: According to our result, KT application with positive input was found effective on pain and function. However effect size was very weak. In addition this improvement was not clinically significant.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193838 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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1419 Targeted Use of Physiotherapy Resources in The COVID Era: How Does Face to Face Physiotherapy Compare with Simple Advice Sheets After Manipulation Under Anaesthetic for Frozen Shoulder?

British Journal of Surgery ◽

10.1093/bjs/znab259.1051 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

R Castelhano ◽

J Woods ◽

H Akehurst ◽

A Mitra ◽

M James ◽

...

Keyword(s):

Health Care Systems ◽

Descriptive Analysis ◽

Frozen Shoulder ◽

Analysis Of Covariance ◽

Excellent Outcome ◽

Care Systems ◽

Shoulder Scores ◽

Group 2 ◽

Clinically Significant ◽

Group 1

Abstract Introduction This study compares two pathways for patients undergoing MUA for FS, one where physiotherapy advice is only given to the patient (Group 1), and the other where supervised hydrotherapy and physiotherapy occur post operatively (Group 2). Method A descriptive analysis of pre- and post-operative Oxford Shoulder Scores and change scores were performed. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on post-operative OSS, with pre-operative OSS as the only covariate. Results The results for post-operative OSS were significantly greater for Group 2 than for Group 1 (40.7 for NHS and 44.7 for private, improvement of 17.32 for NHS and 18.23 for Private). The effect of physiotherapy was significant (p < 0.001). The estimated effect of physiotherapy on postoperative OSS was an increase of 3.2 (95% confidence interval 1.5 – 4.8). Conclusions We detected a statistically significant increase in post-operative OSS in patients treated for frozen shoulder with MUA + physiotherapy compared with patients receiving MUA plus advice alone. These results suggest that physiotherapy does confer a real benefit, however the increased OSS is below the clinically significant level. Therefore, in a resource poor environment, such as may exist during and after COVID in many health care systems, MUA plus physio advice alone gives an excellent outcome for the treatment of FS.

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Comparative analysis of the results and complications of two methods of the open wedge high tibial osteotomy

Rheumatology Science and Practice ◽

10.47360/1995-4484-2021-615-624 ◽

2021 ◽

Vol 59 (5) ◽

pp. 615-624

Author(s):

V. E. Bialik ◽

S. A. Makarov ◽

L. I. Alekseeva ◽

E. I. Bialik ◽

V. A. Nesterenko ◽

...

Keyword(s):

Surgical Technique ◽

High Tibial Osteotomy ◽

Excellent Result ◽

Standard Technique ◽

Tibial Osteotomy ◽

Open Wedge ◽

Wedge High Tibial Osteotomy ◽

Group 2 ◽

One Year ◽

Group 1

Objective – to compare the results and complications of open wedge high tibial osteotomy (OWHTO) in patients operated on according to the standard technique and using the developed method of performing the operation using the original fixator.Materials and methods. 73 patients with primary and secondary OA of the knee I–III stages were recruited into the study, which were divided into 2 groups. Group 1 consisted of 43 patients, who underwent 46 OWHTO from 2005 to 2019 using the standard technique using short plates with a fixed spacer (Puddu I (5 times) and II generation (24 times), Osteomed (17 times)) and bone grafting. Group 2 consisted of 30 patients who were operated on in 2018– 2020 using the developed surgical technique and the original fixator. To assess the result, we studied the change in pain according to the Visual Analog Scale (VAS), as well as the functional (FS) and objective scores (OS) of the knee according to the Knee Society Score (KSS) before surgery, after 3 months and 1 year after OWHTO.Results. In group 1, one year after OWHTO, the results were obtained: excellent in 43.5% of cases, good – in 41.0% and satisfactory – in 15.2% of patients. In group 2, an excellent result was obtained in 59.3% of patients, good – in 33.4% and satisfactory – in 7.3% of cases. In group 1, 15 (32.7%) patients were diagnosed with 26 complications, and in group 2 – 5 (16.6%) patients with 5 complications.Conclusions. The use of the developed surgical technique and the original fixator made it possible to increase the percentage of excellent and good treatment results from 84.5% to 92.7% and to reduce the number of complications associated with OWHTO from 32.7% to 16.6%.

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Study of surgical management of fracture of proximal humerus by PHILOS plate and screws

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201722 ◽

2020 ◽

Vol 6 (3) ◽

pp. 462

Author(s):

Channappa T. Seetharam ◽

Manju Jayaram ◽

Shivakumar H. Bachhappa ◽

Yatish Ramalingaiah ◽

Syed Abdul Hadi

Keyword(s):

Functional Outcome ◽

Proximal Humerus ◽

Plate Fixation ◽

Angular Stability ◽

Rigid Fixation ◽

Functional Evaluation ◽

Proximal Humerus Fractures ◽

Excellent Outcome ◽

Philos Plate ◽

Humerus Fractures

Background: Proximal humerus fracture accounts for about 5% of all fractures in recent advances proximal humerus fractures are often managed operatively with PHILOS plate which provides greater angular stability and study was aimed at to assess functional outcome of PHILOS plate fixation in proximal humerus fractures.Methods: Prospective study of 31 cases of proximal humerus fractures admitted and operated in Kempegowda Institute of Medical Sciences Hospital November 2017 to May 2019 of which 4 patients died due to medical comorbidities so 27 patients were studied. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Constant and Murley (CM) scoring and disabilities of the arm, shoulder and hand (DASH) scoring.Results: CM scoring and DASH scoring was applied to analyze the functional outcome among the cases. Most of the patients had excellent outcome (52%) followed by good (26%), fair (8%) and poor (15%) outcome according to CM scoring and according to DASH scoring 20.21 was mean score and mean CM score was 77.62. Complications observed were impingement in 1 patient, avascular necrosis in 2 patient and non union in 1 case.Conclusions: We conclude that the use of PHILOS plate for the fixation of proximal humerus fractures is a good device as it provides rigid fixation and early mobilisation and prevented complications. Precontoured locking plates work on the principle of angular stability, divergent screws, less disruption of vascularity and less chances of plate failure.

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Prognostic Value of Facial Nerve Antidromic Evoked Potentials in Bell Palsy: A Preliminary Study

International Journal of Otolaryngology ◽

10.1155/2012/960469 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Zhang WenHao ◽

Chen Minjie ◽

Yang Chi ◽

Zhang Weijie

Keyword(s):

Facial Nerve ◽

Evoked Potentials ◽

Early Stage ◽

Excellent Result ◽

External Auditory Meatus ◽

Posterior Wall ◽

Taste Disorder ◽

Group 2 ◽

Bell Palsy ◽

Group 1

To analyze the value of facial nerve antidromic evoked potentials (FNAEPs) in predicting recovery from Bell palsy.Study Design. Retrospective study using electrodiagnostic data and medical chart review.Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1) and 20 cases were not (Group 2). Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR) and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides.Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD) of FNAEP. Mean±SD of AD was−6.96%±12.66% in patients with excellent result,−27.67%±27.70% with good result, and−66.05%±31.76% with poor result.Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery.

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