Second generation locked plating for complex proximal humerus fractures in very elderly patients

Gavaskar, Ashok S.; Karthik, B; Tummala, Naveen C.; Srinivasan, Parthasarathy; Gopalan, Hitesh

doi:10.1016/j.injury.2016.08.010

Cited by 23 publications

(12 citation statements)

References 18 publications

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“…56 , 57 When plating complex fractures, suture fixation of the tuberosities and medial augmentation with cement, bone graft, and calcar screws is suggested ( Figure 6 ). Fractures with valgus impaction have better outcomes than patients with varus impaction in both 3-and 4-part fractures, 58 - 60 so attention to medial support is important. A randomized study comparing complex fractures treated with and without a medial support screw showed superior Constant scores (79 vs 70) and reduced failure rate (3.4% vs 23.1%) in the group that had a medial support screw placed.…”

Section: Managementmentioning

confidence: 99%

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Schumaier

Grawe

2018

Geriatr Orthop Surg Rehabil

159

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Introduction:Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly.Methods:A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years.Results:The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty.Discussion:Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis.Conclusion:A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process.

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Section: Managementmentioning

confidence: 99%

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Schumaier

Grawe

2018

Geriatr Orthop Surg Rehabil

159

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“…Numerous surveys have suggested that angular stable implants provide sufficient fracture stabilization in older patients [ 6 , 7 ]. Of these implants, the proximal humeral internal locking system (PHILOS) (Synthes, Solothurn Switzerland) is a well-established and widely reported implant with good results [ 8 , 9 ]. However, it is frequently associated with high complication rates (up to 28.2%), such as humeral head avascular necrosis (AVN), secondary fracture displacement, screw cut-out with intraarticular penetration, or subacromial impingement with plate [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Preliminary clinical and radiographic outcomes of proximal humeral fractures: comparison of ALPS and PHILOS plating in Asian patients in Taiwan

et al. 2020

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Background: Up to 20% of proximal humeral fractures need to be treated operatively. However, numerus complications were reported by using fixed angled locking plates. The ALPS Proximal Humerus Plating System is a new design implant with novel design features. The aim of this study was to compare the preliminary clinical outcomes and complications of proximal humeral fractures treated with either ALPS or the proximal humeral internal locking system (PHILOS) in Asian patients in Taiwan. Methods: Between January 2016 and December 2018, 66 patients with displaced proximal humeral fractures were analyzed retrospectively, of whom 31 underwent ALPS implant treatment and 35 underwent PHILOS implant treatment. Intraoperative blood loss and operation time, postoperative Constant-Murley Shoulder Outcome (Constant-Murley) score, and complications variables were recorded for the comparison. All cases were regularly followed up for at least 1 year. Results: The mean follow-up period was 400.8 days (range, 367-446 days). Union was achieved in 98.5% of patients (65/66). The ALPS group yielded similar radiologic and clinical outcomes to the PHILOS plating group for treating displaced proximal humeral fractures, including operation time, intraoperative blood loss, the Constant-Murley score, and varus malunion (P > 0.05, respectively). However, the incidence of total postoperative complications in the ALPS group was significantly lower than in the PHILOS group (P < 0.05). There was a trend of a lower complication rate of screws/pegs protrusion, avascular necrosis, subacromial impingement, postoperative infection, and reoperation in the ALPS group, although it was not statistically significant (P > 0.05, respectively). Conclusion: The ALPS group yielded similar radiologic and clinical outcomes to the PHILOS plating group for displaced proximal humeral fractures, but the ALPS group had a significantly lower total rate of complications. Therefore, ALPS may be a better option for treating proximal humeral fractures. Further larger clinical studies are needed to confirm the findings presented here.

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“…Several parameters, such as varus displacement or medial comminution, were significantly correlated with reduction loss [10, 42], but more specific parameters are needed to detect postoperative failures early.…”

Section: Discussionmentioning

confidence: 99%

“…The cortical support on the medial column is of great importance for bone healing in the proximal humerus [43], especially in complex fractures [31, 42, 44-46]. The HTAD seems to illustrate the importance of a stable reduction in operative treatment because it is proportionally greater in the early postoperative radiographs if the medial column is not correctly fixed.…”

Section: Discussionmentioning

confidence: 99%

Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

Saul¹,

Himmelmann²,

Dresing³

2017

TOORTHJ

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Background:Humeral head fractures and their postoperative outcome remain a challenging problem in surgical daily routine. Predictive factors for loss of fixation are rare.Objective:Determination of predictive factors for the failure of osteosynthesis with the loss of fixation or migration of screws in humeral head fractures.Method:From 1995 to 2011, 408 patients with proximal humeral fractures [mean age 66.6 years, 50.9-82.3 years] and osteosynthesis were analyzed. Two hundred and three received open reduction internal fixation (ORIF) with the PHILOS® plate. The non-locking plate was used in 80, the locking plate in 16 and humeral head prosthesis in 26 patients, in addition to 23 patients undergoing other procedures. Intraoperative reduction that achieved an anatomical alignment of the medial aspect of the humerus (humeral calcar) was assessed in 94 patients by postoperative X-ray analysis. The loss of fixation was evaluated by a follow-up of three to five X-rays and measurement of the humeral tip-apex-distance (HTAD).Results:For stable fixed fractures with an intact calcar, percentual HTAD was significantly higher than for unstable fixed fractures (p=0.04). Morbidity, such as hypertension, orthopedic operations or diabetes, strongly influenced the HTAD, while postoperative passive motion treatment modestly affected the HTAD over time.Conclusion:The anatomic reconstruction of the calcar, leading to stable fixation of humeral head fractures, can significantly prevent an overproportioned decrease in the HTAD in postoperative X-rays and seems to be vital in multimorbid patients. Measurement of the HTAD over time delivers a tool for early detection of secondary loss of fixation.

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Second generation locked plating for complex proximal humerus fractures in very elderly patients

Cited by 23 publications

References 18 publications

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

Preliminary clinical and radiographic outcomes of proximal humeral fractures: comparison of ALPS and PHILOS plating in Asian patients in Taiwan

Humeral Tip-apex-distance as a Prognostic Marker for Proximal Humeral Fractures in 203 Patients

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