Evaluation of the Complications of Surgical Treatment of Fractures of the Proximal Extremity of the Humerus Using a Locking Plate

Abstract

Objective: To evaluate the complications from surgical treatment using a locking plate among patients with fractures of the proximal extremity of the humerus. Methods: Between July 2004 and December 2009, 56 patients with fractures of the proximal extremity of the humerus were treated using the PHILOS® plate. There were 19 male patients and 37 female patients, with a mean age of 62 years (range: 30 to 92 years). All the cases had a mean postoperative followup period of 12 months. Thirteen fractures were classified as presenting in two parts, 28 as three, eight as four and seven as epiphyseal fractures. Results: Among the patients operated, 26 were considered to have achieved excellent results, twelve good, ten fair and eight poor, according to the UCLA score. Thirty complications occurred in 20 patients (35.7%), among which the most frequent complication was inadequate reduction of the fracture, which occurred in eight cases. Subacromial impact, caused by the plate, occurred in seven cases, while inadequate fixation occurred in six cases. Other complications such as pseudarthrosis, adhesive capsulitis, avascular necrosis, loss of varus reduction and infection were also seen. Conclusion: The functional results from treating fractures of the proximal extremity of the humerus using a locking plate depended on correct anatomical reduction of the fracture and stable fixation of the implant. Complications still occur frequently, particularly because of intraoperative technical difficulty, fracture severity and possible inexperience of the surgeon.

Is PHILOS as good as it sounds to be? Analysis of complications and functional outcome of PHILOS plating

“…In our study, total of 7 patients out of 32 had complications (21.8%). In literature, the reported complication rates are ranging from 3.7% to 35.7% [9,11,12] The main complication in our study was inadequate reduction of the fracture ( Fig. 1).…”

“…We had one case (3.2%) which was fixed in varus position and healed with malunion. Miyazaki et al [9] reported that 3.3% of their cases developed this complication. Varus malposition is defined as a head shaft angle of less than 120 degrees.…”

“…less than five millimeters from the apex of the greater tubercle [8,16] The rate of occurrence of this complication is about 0-12.5% in literature [6,13,15,16] . To avoid this complication, positioning of the plate has to be accurate and lower than 8mm from apex of the greater tubercle [9] . (Fig.…”

“…Frankhauser et al [6] and Duralde and Leddy [8] reported complication rates of 20-30% with locking plates such as pseudarthrosis, inadequate reduction, subacroimial impact, nerve injuries and infection. Miyazaki AN et al [9] reported overall complication rate of 35.7% with PHILOS plating. Considering the advantages of PHILOS plating and the scarcity of data on the complications, efficacy and the functional outcome following internal fixation with PHILOS plate for displaced proximal humerus fractures, the present study was planned to analyse complications and overall outcome at our center.…”

Fluoroscopic Technique for Open Reduction and Internal Fixation of Proximal Humeral Fracture Using the Proximal Humeral Locking Plate: Proposal of “Plate” and “Screw” Views

“…The greater number of complications were associated with incorrect surgical technique, with 40% of complications already presented at the end of the procedure. 9 …”