A practical guide for the use of contour locking plates for the repair of humeral diaphyseal fractures with proximal extension

Zamboni, Caio; Carmo, Bruno L.; Moraes, Leonardo V. M.; Hungria, José Octávio Soares; Mercadante, Marcelo Tomanik; Fucs, Patricia M. M. B.

doi:10.1016/j.injury.2019.09.026

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…However, despite the 45 • twisted shape with an additional anterior curvature, the plate was not able to completely avoid the anterior part of the deltoid insertion, as it was partially compromised in all specimens after ALPS insertion with MIPO technique. Interestingly, Zamboni et al evaluated the fit of helical and twisted plates on artificial and cadaveric bones and concluded that a 70 • twisted shape fits best to the contour of the humerus, as compared with helical implants which lay more distant to the bone [34].…”

Section: Discussionmentioning

confidence: 99%

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Pastor,

Zderic,

Pastor

et al. 2023

Medicina

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Background and Objectives: The surgical treatment of proximal humeral shaft fractures usually considers application of either long straight plates or intramedullary nails. By being able to spare the rotator cuff and avoid the radial nerve distally, the implementation of helical plates might overcome the downsides of common fixation methods. The aims of the current study were (1) to explore the biomechanical competence of different plate designs and (2) to compare their performance versus the alternative treatment option of using intramedullary nails. Materials and Methods: Twenty-four artificial humeri were assigned to the following four groups for simulation of an unstable proximal humeral shaft fracture and instrumentation: Group 1 (Straight-PHILOS), Group 2 (MULTILOC-Nail), Group 3 (45°-Helical-PHILOS), and Group 4 (90°-Helical-PHILOS). All specimens underwent non-destructive, quasi-static biomechanical testing under loading in axial compression, torsion in internal/external rotation, and pure bending in four directions, accompanied by motion tracking. Results: Axial stiffness/displacement in Group 2 was significantly higher/smaller than in all other groups (p ≤ 0.010). Torsional displacement in Group 2 was significantly bigger than in all other groups (p ≤ 0.017). Significantly smaller coronal plane displacement was identified in Group 2 versus all other groups (p < 0.001) and in Group 4 versus Group 1 (p = 0.022). Significantly bigger sagittal plane displacement was detected in Group 4 versus all other groups (p ≤ 0.024) and in Group 1 versus Group 2 (p < 0.001). Conclusions: Intramedullary nails demonstrated higher axial stiffness and smaller axial interfragmentary movements compared with all investigated plate designs. However, they were associated with bigger torsional movements at the fracture site. Although 90°-helical plates revealed bigger interfragmentary movements in the sagittal plane, they demonstrated improved resistance against displacements in the coronal plane when compared with straight lateral plates. In addition, 45°-helical plates manifested similar biomechanical competence to straight plates and may be considered a valid alternative to the latter from a biomechanical standpoint.

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Section: Discussionmentioning

confidence: 99%

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Pastor,

Zderic,

Pastor

et al. 2023

Medicina

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“…In the light of the available evidence, the idea of twisting and bending long PHILOS plates to conform to the humeral anatomy and to use them for fixation in metaphysiodiaphyseal fractures was first reported by Brunner et al (16), in 2012. In the following years, a series of cases treated with the open or minimally invasive percutaneous osteosynthesis (MIPO) principle using long PHILOS or helical plates have been reported (2,6,8,12,13,(17)(18)(19)(20)(21)(22) Conventional helical plate application was first introduced in 2005 by Yang et al (23), however, the fixation was usually not possible in fractures extending to the proximal humerus with conventional helical plates (23). In these types of fractures, there may not be enough proximal fixation area for screw insertion.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, today long PHILOS plates are replacing conventional narrow plates. In 2014, 12 cases by Moon et al (25), 46 cases by Wang et al (15), in 2018, and 8 cases by Zamboni et al (21), in 2019 a small number of cases were treated with the minimally invasive technique using the helical plate. The common aim of these cases was to create a safe submuscular tunnel between the distal and proximal humerus while bridging the fractured segment.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive plate osteosynthesis for segmental humerus fractures with a helical plate. Which distal fixation—the anterior or lateral—is superior?

AYDOGAN>

AKAR>²,

Pehlivanoğlu³

et al. 2022

Journal of Health Sciences and Medicine

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Aim: In order to achieve adequate stability in segmental humerus fractures, the PHILOS fixation with minimal invasive approach comes into use instead of conventional plating. However, according to the AO classification, 12C type segmental humerus fractures treated with minimally an invasive method are prone to complications. The purpose of this prospective study is to compare functional outcomes and complication rates following two different angled helical PHILOS plate fixation. Material and Method: This multicenter study is a prospective review of cases with a final follow-up outcome. Twenty-two patients with AO 12-C humerus fractures underwent PHILOS fixation with contoured PHILOS plates between January 2016 and June 2019. Patients evaluated in two groups. Group 1 consisted 12 patients who were treated with a 30° helical plate and Group 2 consisted 10 patients who were treated with 70° helical plate. Clinical outcomes were noted according to the Constant-Murley scoring system. Results: The mean age of patients treated in groups 1 and 2 were 49±15.8 and 50.7±17, respectively. Fractures healed in an average of 13.1±3.9 weeks in Group 1 and 13.8±3.1week in Group 2, respectively. The mean follow-up period of the patients was 18±6.1months in Group 1 and 22±4.2 months in Group 2. Mean Constant-Murley scores at final follow-up were 88±2.7 and 90±2.5 in Groups 1 and 2 respectively (p=.665). Radial nerve neuropraxia was seen in 2 cases in Group 1, and a sensorial injury of the musculocutaneous nerve was seen in 1 patient in Group 2 (p=.365). Conclusion: Similar union rates and successful clinical results were obtained from both groups. However, this study suggests that the 70° angled helical PHILOS technique could be performed relatively easily in AO 12-C fractures with fewer complication rates. Musculocutaneous nerve affliction can be as functionally destructive as radial nerve affliction.

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MIPO helical pre-contoured plates in diaphyseal humeral fractures with proximal extension. Surgical technique and results

García-Virto

Santiago-Maniega

Llorente-Peris

et al. 2021

Injury

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A practical guide for the use of contour locking plates for the repair of humeral diaphyseal fractures with proximal extension

Cited by 3 publications

References 17 publications

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Helical Plating Compared with Straight Plating and Nailing for Treatment of Proximal Third Humeral Shaft Fractures—A Biomechanical Study

Minimally invasive plate osteosynthesis for segmental humerus fractures with a helical plate. Which distal fixation—the anterior or lateral—is superior?

MIPO helical pre-contoured plates in diaphyseal humeral fractures with proximal extension. Surgical technique and results

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