Minimal invasive long PHILOS®-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus

Rancan, Mario; Dietrich, Michael; Lamdark, Tenzin; Can, Uenal; Platz, Andreas

doi:10.1016/j.injury.2010.07.235

Cited by 56 publications

(54 citation statements)

References 23 publications

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“…However, by contrast, it is seen commonly when the delta-split approach is employed, when there are concerns regarding injury to the axillary nerve with subsequent dysfunction of the anterior deltoid [15,16]. Although in a recent study injury to the axillary nerve was not observed, the axillary nerve is in danger according to previous studies [17]. The plate is inserted through a tunnel created proximal to distal along the lateral surface of the humerus and beneath the axillary nerve.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Zhou

Gao

Tang

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate clinical outcomes and complications following minimally invasive plate osteosynthesis (MIPO) with the proximal humeral internal locking system (PHILOS) for treating proximal humeral shaft fracture through the deltopectoral approach. Methods Between November 2008 and March 2010, 74 patients with unilateral proximal humeral shaft fractures were treated using the MIPO technique with the PHILOS through the deltopectoral approach. Patients received an average follow-up of 16.9 (range, 12-24) months, and the final follow-up included anteroposterior and lateral imaging and recording of postoperative complications. The Constant-Murley shoulder score was used to evaluate function. Results No intraoperative complications occurred. Postoperative complications included subacromial impingement in four patients. There was no deep infection, neurovascular damage, breakage or implant loosening. All fractures united in an average time of 17.4 (15-25) weeks. In terms of function, the Constant-Murley score was 85.8 points on average (range, 67-100). The range of motion of the involved shoulder was satisfactory, and pain-free in 83.8 % of patients. Conclusions Using the MIPO technique with the PHILOS through the deltopectoral approach is a valid and safe method of treating proximal humeral shaft fractures.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Zhou

Gao

Tang

et al. 2012

International Orthopaedics (SICOT)

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“…22 Minimally invasive plate osteosynthesis is a viable technique for the geriatric population with proximal humeral fracture with shaft extension, and good results have been reported. 23 However, MIPO for this indication is very operator dependent. Lau et al 24 managed 10 older patients with minimally invasive plating with 5 complications including 2 radial nerve injuries, delayed union, and plate impingement.…”

Section: Discussionmentioning

confidence: 99%

Open Reconstruction of Complex Proximal Metadiaphyseal Fragility Fractures of the Humerus

James

Farrell

Evans

et al. 2014

Geriatr Orthop Surg Rehabil

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Purpose: A proactive surgical and rehabilitation protocol was implemented to manage humeral fractures involving both the proximal end and shaft in an older patient population. Primary treatment goals were early return to function and reliable fracture union with minimal complications. Methods: From 2008 to 2012, 21 such operations were performed; 18 were considered ''fragility'' fractures based on mechanism, patient age, and evidence of osteopenia or osteoporosis. Open reduction and internal fixation (ORIF) was employed using direct reduction and fixation with a long periarticular locking plate. Physiotherapy was commenced 2 weeks postoperatively. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess functional outcome at a time point greater than 1 year postoperative. Results: The study group consisted primarily of elderly females (83% with a median age of 69 years) whom sustained complex metadiaphyseal proximal humeral fractures after simple mechanical fall (78%). Uneventful union occurred in all cases. Local complications included 1 case of partial radial nerve palsy, which had resolved completely by 1 year. No cases of infection were identified. Long-term return to functionality was evident with a median DASH score of 12 (mean ¼ 21, standard deviation ¼ 20, n ¼ 13). Seventy five percent of patients reported minimal or no pain (question [Q] 24), and 75% achieved return of overhead function (Q6, 12, and 15). Conclusion: Treatment of complex metadiaphyseal fragility fractures with anatomic reduction, fixed angle plating, and early physiotherapy returns the older patient to optimized functionality with minimal risk of complication. The DASH outcomes are equivalent to ORIF of isolated proximal humerus fractures and clinically indistinguishable from the general population.

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“…대부분 고에너지 손상으로 심한 전위 또는 불안정 성을 보이는 경우가 많으며, 영양 혈관 및 골주위 연부 조 직의 손상으로 보존적 치료 시에는 불유합, 부정유합, 및 견관절의 기능적 장애 등의 합병증이 발생할 가능성이 높 아 수술적 치료를 필요로 한다 [1][2][3]6) . 저자들의 연구에서도 상완골 근위부의 골절이 간부로 확장되거나 간부의 분절 골절이 동반된 복합 골절의 성공적인 치료를 위한 대 원칙 은 최소의 연부 조직 손상과 금속물을 이용한 견고한 내고 정이다 1,9,11) . 대표적인 수술 방법으로서 금속판 내고정술, 골수강내 금속정 고정술이 사용되고 있으나 임상적 결과는 현재까지 매우 제한적으로 보고되고 있다 1,2,5,9,12) .…”

Section: 고 찰 상완골 근위부와 간부를 침범하는 복합 골절의 발생률에 대해서는 잘 알려져 있지 않지만 비교적 드문 unclassified

“…저자들의 연구에서도 상완골 근위부의 골절이 간부로 확장되거나 간부의 분절 골절이 동반된 복합 골절의 성공적인 치료를 위한 대 원칙 은 최소의 연부 조직 손상과 금속물을 이용한 견고한 내고 정이다 1,9,11) . 대표적인 수술 방법으로서 금속판 내고정술, 골수강내 금속정 고정술이 사용되고 있으나 임상적 결과는 현재까지 매우 제한적으로 보고되고 있다 1,2,5,9,12) . …”

Section: 고 찰 상완골 근위부와 간부를 침범하는 복합 골절의 발생률에 대해서는 잘 알려져 있지 않지만 비교적 드문 unclassified

Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus

2011

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Purpose:To evaluate the results of antegrade interlocking intramedullary nailing for complex fractures of the proximal and midshaft of the humerus. Materials and Methods: We retrospectively analyzed the clinical and radiologic results in 11 cases, which were treated by antegrade interlocking intramedullary nail. We assessed clinical outcomes according to ASES scoring system and radiological result. Results: All cases had bony union and the mean union period was 14.7 weeks. Postoperative complications were 1 loss of fixation, 2 proximal protrusion of nail and 2 temporary shoulder pain. A case with loss of fixation was treated open reduction and refixation and had union at 14 weeks postoperatively. The mean ASES score was 85.9 and the clinical outcomes were 4 excellent, 5 good, 1 fair and 1 poor. Conclusion: Intramedullary nailing for complex fractures of the proximal and midshaft of the humerus can offer a reliable treatment option.

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Minimal invasive long PHILOS®-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus

Cited by 56 publications

References 23 publications

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Open Reconstruction of Complex Proximal Metadiaphyseal Fragility Fractures of the Humerus

Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus

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