Long Philos Plate Fixation for Complex Humeral Fractures

Pimple, M.; Chidambaram, R.; Mok, D.

doi:10.1111/j.1758-5740.2010.00085.x

Cited by 8 publications

(9 citation statements)

References 9 publications

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“…Both nailing and plating techniques have been described so far for the treatment of displaced proximal metadiaphyseal humerus fractures with reasonable results [1][2][3]6,17]. Although minimally invasive approaches can be applied using indirect methods for fracture reduction, a single extensile approach is usually necessary [1].…”

Section: Discussionmentioning

confidence: 99%

“…In this scenario, additional iliac crest autograft with or without augmentation with strut grafts should be applied to facilitate fracture healing [18]. Apart from metadiaphyseal fractures, humeral shaft fractures and nonunions with poor bone stock that require long plate fixation and multiple screws insertion to proximal metaphysis and humeral head for achieving construct stability are also candidates for application of the method [17].…”

Section: Discussionmentioning

confidence: 99%

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A New Surgical Technique and Clinical Outcomes of Operated Proximal Metadiaphyseal Humeral Fractures and Nonunions With the Use of Reversed Anatomic Distal Femoral Locking Plate

Chalidis

Kitridis

Givissis

2021

Cureus

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IntroductionProximal humeral fractures complicated with metaphyseal and diaphyseal extension are usually treated operatively with 3.5 mm long anatomic proximal humerus plates. However, frequently these comminuted and segmental fracture types may be associated with delayed union, nonunion, and/or plate failure. We present a technique for addressing this fracture pattern by using an anatomic contralateral 4.5 mm distal femoral plate in a reversed fashion. MethodsEleven patients (eight women and three men) with a mean age of 70 years (range, 52 to 84 years) were operated on with the described technique. The dominant hand was involved in seven out of 11 patients. There were seven acute metadiaphyseal fractures and four nonunions. In one patient, humeral shaft nonunion was associated with segmental metadiaphyseal defect and a free fibular graft was applied. ResultsAll fractures healed and patients regained almost normal function of the affected shoulder and upper limb. Shoulder abduction and forward elevation ranged from 80 to 110 degrees (mean, 97 degrees) and 90 to 120 degrees (mean, 102 degrees), respectively. The disabilities of the arm, shoulder and hand (DASH) score varied from 6 to 11 points (median 8). No major trauma or systemic complications were recorded. ConclusionThe morphology, strength, and characteristics of the plate could effectively conform to the anatomy of the proximal humerus and offer adequate stability for fracture union. The described technique is more useful in case of osteoporosis and/or presence of previous failed internal fixation that further compromise the vascularization and the mechanical properties of the bone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A New Surgical Technique and Clinical Outcomes of Operated Proximal Metadiaphyseal Humeral Fractures and Nonunions With the Use of Reversed Anatomic Distal Femoral Locking Plate

Chalidis

Kitridis

Givissis

2021

Cureus

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“…13 A study of 18 long PHILOS plate fixations for a mixture of pathologies by Pimple et al reported no non-unions, with a mean residual pain of 0.8 as assessed by the VAS. 5 The results of this series, which looked purely at nonpathological fractures and excluded peri-prosthetic fractures, compare unfavourably with a non-union rate of 12% and a mean residual pain of 3.6 on the VAS scale. On analysis of the nonunions, we could not identify any specific predisposing factors to predict non-union but are limited in analysis by the small sample size.…”

Section: Discussionmentioning

confidence: 99%

“…The one English language paper on the subject is a mixed series involving traumatic, pathological and peri-prosthetic fractures. 5 The present study aimed to assess the medium-term results of traumatic proximal humerus fractures with distal metaphyseal or diaphyseal extension treated with long contoured proximal humerus internal locking system (PHILOS) plates (Synthes, Stratec Medical, Oberdorf, Switzerland).…”

Section: Introductionmentioning

confidence: 99%

Long contoured locking plate fixation of traumatic proximal humeral fractures with distal extension

et al. 2014

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Background: There is a paucity of data available with respect to outcome on long contoured locking plate fixation for proximal humerus fractures with distal fracture extension. Methods: Thirty-four patients with traumatic proximal humerus fractures with distal extension underwent fixation with long contoured locking plates. Twenty-five patients (74%) were included in the study: one patient died, two patients had unrelated illnesses resulting in them being unable to complete follow-up assessment and six were lost to follow-up. Patients' case notes and radiographs were retrospectively reviewed, and patients were contacted to assess functional outcome using the Visual Analogue Scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) score, Oxford Shoulder Score (OSS) and Stanmore Percentage of Normal Shoulder Assessment (SPONSA). Results: Mean follow-up was 27 months (range 11 months to 60 months). Mean pain at final follow-up was 3.6 [95% confidence interval (CI) ¼ 2.5 to 4.8] with only four patients having residual pain greater than 5 on the VAS scale. Mean DASH score was 41.2 (95% CI ¼ 32.0 to 50.4), mean OSS was 29.1 (95% CI ¼ 24.3 to 33.9) and mean SPONSA was 63.9% (95% CI ¼ 50.8 to 77.2). There was one wound infection. Three patients had non-unions that required bone grafting and revision internal fixation. Conclusions: We feel long contoured locking plates represent a useful treatment option for complex proximal humerus fractures

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“…However, fixation of proximal and distal fractures is not possible with the anterior opening MIPO technique. For this purpose, it has been reported in a limited number of studies that extended segment fractures could be treated by using the anatomical PHILOS plate (2,8,9). Hence, it is possible to protect the deltoid insertion, to use the distal anterior surface for fixation of the distal screws, and to move away from the radial nerve zone by applying PHILOS plates that are helically shaped manually.…”

Section: Introductionmentioning

confidence: 99%

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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Long Philos Plate Fixation for Complex Humeral Fractures

Cited by 8 publications

References 9 publications

A New Surgical Technique and Clinical Outcomes of Operated Proximal Metadiaphyseal Humeral Fractures and Nonunions With the Use of Reversed Anatomic Distal Femoral Locking Plate

A New Surgical Technique and Clinical Outcomes of Operated Proximal Metadiaphyseal Humeral Fractures and Nonunions With the Use of Reversed Anatomic Distal Femoral Locking Plate

Long contoured locking plate fixation of traumatic proximal humeral fractures with distal extension

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

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