The PHILOS plate for proximal humeral fractures—Risk factors for complications at one year

Spross, Christian; Platz, Andreas; Rufibach, Kaspar; Lattmann, Thomas; Forberger, Jens; Dietrich, Michael

doi:10.1097/ta.0b013e31822c1b5b

Cited by 82 publications

(63 citation statements)

References 22 publications

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“…In one recent systematic review the overall rate of complications was 49% including varus malunion, 33% excluding varus malunion, and reoperation rate was 14%. The most common complications included varus malunion 16%, AVN 10%, screw perforation of the humeral head into the joint 8%, subacromial impingement 6%, and infection 4% [26] . Various studies have stressed out the association of high rate of complications and need for reoperation [23,26,27] .…”

Section: Discussionmentioning

confidence: 99%

Philos Plate in Proximal Humerus Fracture–Its Functional Outcome and Complications

Bansal

Sohal

Bhoparai

2015

International Journal of Orthopaedics

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AIM:Technique for the fixation of two, three, and four part proximal humerus fractures has rapidly shifted towards the use of locking plates. The objective of this prospective study was to evaluate functional outcome and complications of proximal humeral fractures managed with proximal humerus internal locking system (PHILOS). METHODS: 16 men and 9 women aged 19 to 82 (mean, 49.24) with an acute proximal humerus fracture were treated with PHILOS plate by using deltopectoral approach. Outcome measurements included Constant score, complications, and radiographic assessment. RESULTS: 11 patients had 2-part fractures, 11 patients had 3-part fractures, and 3 patients had 4-part fractures. After 6 month follow up, a mean Constant score 57.4 was achieved. Outcomes were excellent in 16%, good in 44%, fair in 16% while poor in 24%. The Constant score was poorer for Neer type IV fractures as compared to other types. The most frequently occurring complications in our patients were malreduction 20%, screw perforation 16%, infection 12%, avascular necrosis 8%, frozen shoulder 8%, impingement 4% and plate pull out 4%. CONCLUSION: Fixation of proximal humerus fractures with proximal humerus locking plates is associated with satisfactory functional outcomes in 2-part and 3-part fracture. The incidence of complications and subsequent re-operation is relatively high. Advanced surgical skills and surgeon's experience are considered to be more critical for successful operative treatment.

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Section: Discussionmentioning

confidence: 99%

Philos Plate in Proximal Humerus Fracture–Its Functional Outcome and Complications

Bansal

Sohal

Bhoparai

2015

International Journal of Orthopaedics

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“…A radiologist (NK) independently analyzed the BMD of the same shoulders on pQCT, using a validated protocol for the proximal humerus [14]. Measurement of the cancellous bone of the humeral head was used as the standard of reference for local BMD, as this area is the most common location of failure after ORIF for proximal humerus fractures [11,24]. Correlations between the deltoid tuberosity index and the Tingart measurement, between the deltoid tuberosity index and the Tingart measurement and BMD of the humeral head, and between the deltoid tuberosity index and Tingart measurement and age were calculated.…”

Section: Measurement Of the Deltoid Tuberosity Indexmentioning

confidence: 99%

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures

Spross

Kaestle

Benninger

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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112

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Background Osteoporosis may complicate surgical fixation and healing of proximal humerus fractures and should be assessed preoperatively. Peripheral quantitative CT (pQCT) and the Tingart measurement are helpful methods, but both have limitations in clinical use because of limited availability (pQCT) or fracture lines crossing the area of interest (Tingart measurement). The aim of our study was to introduce and validate a simple cortical index to assess the quality of bone in proximal humerus fractures using AP radiographs. Questions/purposes We asked: (1) How do the deltoid tuberosity index and Tingart measurement correlate with each other, with patient age, and local bone mineral density (BMD) of the humeral head, measured by pQCT? (2) Which threshold values for the deltoid tuberosity index and Tingart measurement optimally discriminate poor local bone quality of the proximal humerus? (3) Are the deltoid tuberosity index and Tingart measurement clinically applicable and reproducible in patients with proximal humerus fractures? Methods The deltoid tuberosity index was measured immediately above the upper end of the deltoid tuberosity. At this position, where the outer cortical borders become parallel, the deltoid tuberosity index equals the ratio between the outer cortical and inner endosteal diameter. In the first part of our study, we retrospectively measured the deltoid tuberosity index on 31 patients (16 women, 15 men; mean age, 65 years; range, 22-83 years) who were scheduled for elective surgery other than fracture repair. Inclusion criteria were available native pQCT scans, AP shoulder radiographs taken in internal rotation, and no previous shoulder surgery. The deltoid tuberosity index and the Tingart measurement were measured on the preoperative internal rotation AP radiograph. The second part of our study was performed by reviewing 40 radiographs of patients with proximal humerus fractures (31 women, nine men; median age, 65 years; range, 22-88 years). Interrater (two surgeons) and intrarater (two readings) reliabilities, applicability, and diagnostic accuracy were assessed. Results The correlations between radiograph measurements and local BMD (pQCT) were strong for the deltoid tuberosity index (r = 0.80; 95% CI, 0.63-0.90; p \ 0.001) and moderate for the Tingart measurement (r = 0.67; 95% CI, 0.42-0.83; p \ 0.001). There was moderate correlation between patient age and the deltoid tuberosity index (r = 0.65; p \ 0.001), patient age and the Tingart measurement (r = 0.69; p \ 0.001), and patient age and pQCT (r = 0.73; p \ 0.001). The correlation between the deltoid tuberosity index and the Tingart measurement was strong (r = 0.84; p \ 0.001). We determined the cutoff value for Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Inte...

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“…[6][7][8] However, treatment using locking plates has been shown to be associated with postoperative complications such as avascular necrosis, intra-articular penetration of the locking screws. 11,17,18) Our study also described a subset of patients with postoperative complications such as intraarticular perforation of locking screws and non-union. Despite surgical treatment, we also found that 6 patients (11%) still had a 'poor' Constant score.…”

Section: Discussionmentioning

confidence: 99%

“…In general, avascular necrosis is a relatively commonly occurred complication in treating proximal humeral fractures, however in our study none was seen with this complication. 17,28) This could be because the elapsed time was short and a preferential treatment of humeral head replacement over locking plates in the patients aged over 70 who had a 4-part fracture.…”

Section: Discussionmentioning

confidence: 99%

The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

Lee¹,

Hwang²,

Kim³

et al. 2014

Clin Shoulder Elbow

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Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications. Results: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient). Conclusions: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support. (Clin Shoulder

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The PHILOS plate for proximal humeral fractures—Risk factors for complications at one year

Cited by 82 publications

References 22 publications

Philos Plate in Proximal Humerus Fracture–Its Functional Outcome and Complications

Philos Plate in Proximal Humerus Fracture–Its Functional Outcome and Complications

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures

The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

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