PHILOS Synthesis for Proximal Humerus Fractures Has High Complications and Reintervention Rates: A Systematic Review and Meta-Analysis

Abstract

Purpose: The aim of this study was to quantify the rate of complications and reinterventions in patients treated with PHILOS plate for proximal humerus fractures (PHFs) synthesis. Methods: A comprehensive literature search was performed on the PubMed, Web of Science, Embase, and Cochrane databases up to 7 October 2021. Studies describing medium and long-term complications in PHF synthesis using the PHILOS plate were included. A systematic review and meta-analysis were performed on complications and causes of reinterventions. Assessment of risk of bias and quality of evidence was performed with the Downs and Black’s “Checklist for Measuring Quality”. Results: Seventy-six studies including 4200 patients met the inclusion criteria. The complication rate was 23.8%, and the main cause was screw cut-out (4.1%), followed by avascular necrosis (AVN) (3.1%) and subacromial impingement (1.5%). In patients over 55 years, the complication rate was 29.5%. In the deltopectoral (DP) approach the complication rate was 23.8%, and in the delto-split (DS) it was 17.5%, but no difference between the two approaches was seen when considering the type of fracture. The overall reintervention rate was 10.5% in the overall population and 19.0% in older patients. Conclusions: Proximal humerus synthesis with a PHILOS plate has high complications and reintervention rates. The most frequent complication was screw cut-out, followed by humeral head AVN and subacromial impingement. These results need to be further investigated to better understand both the type of patient and fracture that is more at risk of complications and reintervention and to compare pros and cons of the PHILOS plate with respect to the other solutions to manage PHFs.

A study on the functional and radiological outcome with complications in the management of proximal humerus fractures operated with proximal humerus internal locking osteosynthesis system

“…Erasmo et al did a study on 82 cases of proximal humerus fractures treated with PHILOS plating over a period of 4 years and found that 12% cases under went avascular necrosis. 23 27 The different functional outcomes of our study to other studies are enumerated in (Table 5).…”

“…International Journal of Research in Orthopaedics | May-June 2023 | Vol 9 | Issue 3 Page 557proximal humerus fractures 27. According to the Oldrini et al meta-analysis, functional outcomes were excellent in 3 studies (7.7%), good in 21 (53.8%), moderate in 13 studies (33.4%), and poor in 2 studies (5.1%).…”

Comment on Oldrini et al. PHILOS Synthesis for Proximal Humerus Fractures Has High Complications and Reintervention Rates: A Systematic Review and Meta-Analysis. Life 2022, 12, 311

“…We read the paper published by Oldrini, L.M. et al (2022) [ 1 ] with great interest. The paper is a systematic review and meta-analysis addressing a crucial topic regarding the complications and reinterventions in patients who have been surgically treated with PHILOS plates for proximal humerus fracture fixation.…”

Reply to Sidiropoulos, K.; Tsikopoulos, K. Comment on “Oldrini et al. PHILOS Synthesis for Proximal Humerus Fractures Has High Complications and Reintervention Rates: A Systematic Review and Meta-Analysis. Life 2022, 12, 311”

“…Thank you for the opportunity to respond to the commentary [ 1 ] on our recent article “PHILOS Synthesis for Proximal Humerus Fractures Has High Complications and Reintervention Rates: A Systematic Review and Meta-Analysis” [ 2 ]. We read the commentary with much interest, and we are happy to address all the issues posed.…”