Mid-term results of minimally invasive deltoid-split versus standard open deltopectoral approach for PHILOS™ (proximal humeral internal locking system) osteosynthesis in proximal humeral fractures

Borer, Joëlle; Schwarz, Jochen; Potthast, Silke; Jakob, Marcel; Lenzlinger, Philipp M.; Zingg, Urs; Babians, Arby

doi:10.1007/s00068-019-01076-7

Cited by 11 publications

(30 citation statements)

References 23 publications

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“…Their results showed that the median Constant and ASES scores were 78 (52-95) and 77 (62-96) at the final follow-up, respectively, and the majority of patients were painless with a well-functioning shoulder at the lasted follow-up. Similar functional outcomes have been reported in a previous study 22 assessing the clinical outcomes in 18 patients with 2-part PHFs experiencing osteosynthesis with a PHILOS plate demonstrated the median Constant shoulder score was 83 (79-87) and the median Disabilities of Arm, Shoulder and Hand Outcome Measure (DASH) score was 25 (24)(25)(26)(27). In a retrospective study 23 involving 8 patients with 2-part PHFs treated with a PHILOS plate, the Constant score was 64 (56-72).…”

Section: Discussionsupporting

confidence: 91%

Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely – A Retrospective Study

Cheng

Dong

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction To date, there is little research assessing the efficacy of a proximal humeral internal locking system (PHILOS) plate plus an allogeneic fibula inserted obliquely in the treatment of 2-part proximal humerus fractures (PHFs) with calcar comminution in patients >60 years old with severe osteoporosis. The aim of this study was to retrospectively evaluate the outcomes of elderly patients with osteoporotic 2-part PHFs combined with medial column (calcar) instability or disruption who experienced a PHILOS plate plus an allogeneic fibula inserted obliquely. Materials and Methods One hundred and twelve consecutive elderly patients with severe osteoporotic 2-part PHFs combined with calcar instability or disruption who were treated with a PHILOS plate plus an allogeneic fibula inserted obliquely were retrospectively identified from 3 tertiary medical centres during 2014–2019. The primary outcomes were the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores; secondary outcome was the rate of key orthopaedic complications. Results Median follow-up was 24 (15.3–27.6) months. Significant improvements in the median Constant scores were observed (39 [26–58 points] prior to surgery vs 81 [67–95 points] at final follow-up). The median ASES scores improved from 43 (26–64 points) prior to surgery to 83 (65–96 points) at final follow-up. The percentage of key orthopaedic complications was 25.6% (22/86). Four (4.7%) cases had loss of reduction, 4 (4.7%) experienced aseptic loosening, 1 (.8%) had non-union, 4 (4.7%) suffered a periprosthetic fracture, 3 (3.5%) experienced a revision surgery, 1 (.8%) had a dislocation and 5 (5.8%) suffered an unbearable shoulder pain. Conclusion For elderly patients with osteoporotic 2-part PHFs combined with calcar instability or disruption, PHILOS plate combined with an allogeneic fibula inserted obliquely might have recognisable advantages in decreasing the loss of fixation and preventing medial calcar collapse.

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Section: Discussionsupporting

confidence: 91%

Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely – A Retrospective Study

Cheng

Dong

et al. 2021

Geriatr Orthop Surg Rehabil

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“…In the present study, based on grouping the patients according to the intra-individual point difference of outcome (MCID), patients with poor outcomes in the CMS also had a reduced quality of life in the mid-term [11]. The current literature indicates that the average CMS score ranges from 60 to 79, depending on the study design and follow-up period [9,10,23,24,25]. Two recent metaanalyses confirmed this range, with mean CMS scores of 62-90 and 75-81, respectively [26,27].…”

Section: Discussionmentioning

confidence: 79%

Das schulterspezifische Outcome nach proximaler Humerusfraktur hat Einfluss auf die mittelfristige allgemeine Lebensqualität

et al. 2022

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Zusammenfassung Hintergrund Die operative Therapie der proximalen Humerusfraktur ist ein etabliertes Verfahren. Es zeigte sich, dass postoperative Komplikationen einen signifikanten Einfluss auf das schulterspezifische Outcome haben. Wenig ist bisher bekannt über einen Einfluss auf die verletzungsunabhängige Lebensqualität. Ziel der Arbeit Ziel dieser retrospektiven Studie ist es, zu analysieren, ob Patienten mit einem schlechten funktionellen Outcome nach operativ versorgter proximaler Humerusfraktur mittelfristig ebenso eine eingeschränkte allgemeine Lebensqualität aufweisen. Ein Schwerpunkt liegt auf der Analyse von Patienten mit schlechtem funktionellem Outcome aufgrund von postoperativen Komplikationen. Material und Methoden Auswertung aller im Zentrum operierten Patienten mit einer proximalen Humerusfraktur im Zeitraum vom 01.01.2005 bis 31.12.2015 und Nachuntersuchung mittels validierter Scores (Constant-Murley Score [CMS], EQ-5D). Es wurden 2 Gruppen, Gruppe A mit gutem Outcome (∆CMS ≤ 15P.) und Gruppe B mit schlechtem Outcome (∆CMS ≥ 16P.), definiert. Weiterhin wurden im Vorfeld deskriptive Variablen inkl. Definition einer Komplikation festgelegt. Ergebnisse Es wurden 138 Patienten in die Studie eingeschlossen (Gruppe A: 91, Gruppe B: 47). Das durchschnittliche Follow-up beträgt 93,86 Monate ± 37,33 (36–167). Gruppe B hatte signifikant mehr Komplikationen. Weiterhin zeigte sich, dass Patienten mit einem schlechten Outcome bez. der Schulter (Gruppe B) auch einen signifikant niedrigeren EQ-VAS (78,9 ± 19,2 [20,0–100] vs. 70,4 ± 19,5 [15,0–98,0]; p = 0,008) und EQ-Index (0,91 ± 0,14 [0,19–1,00] vs. 0,82 ± 0,17 [0,18–1,00]; p < 0,001) haben. Diskussion Zusammenfassend weisen in der vorliegenden Studie die Patienten mit einem schlechten Outcome der Schulterfunktion im CMS nach durchschnittlich mehr als 6 Jahren Follow-up eine signifikant niedrigere generelle Lebensqualität auf. Das schlechte Outcome ist auf eine signifikant höhere postoperative Komplikationsrate zurückzuführen. Dies war unabhängig von der vorliegenden Frakturmorphologie und vom verwendeten operativen Verfahren.

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“…[7,8] Various methods have been proposed to treat displaced proximal humerus fractures, including conservative treatment, open reduction and internal fixation (ORIF), and shoulder arthroplasty. [9][10][11] With the use of locking plates, ORIF can achieve excellent fracture reduction, can allow early functional exercise, and is highly recommended by orthopedic surgeons, [7,12] particularly in patients aged younger than 65 years old. [11] The optimal surgical approach for proximal humeral fractures remains controversial.…”

Section: Introductionmentioning

confidence: 99%

“…[4,[13][14][15] The DS approach has become a new method for exposing the proximal humerus and has also been applied in rotator cuff surgery and intramedullary nailing. [4,7,13,[16][17][18] This approach consists of entering the proximal humerus fracture between the anterior and middle bands of the deltoid. It provides superior exposure of the lateral and posterior portions of the proximal humerus without extensive exposure of the surrounding soft tissue.…”

Section: Introductionmentioning

confidence: 99%

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Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach

Liu

Wang

et al. 2022

Medicine

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Background: The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach. Methods: This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients’ functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score. Results: A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12–21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation ( P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups ( P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group ( P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group ( P = .049). Conclusion: The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.

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Mid-term results of minimally invasive deltoid-split versus standard open deltopectoral approach for PHILOS™ (proximal humeral internal locking system) osteosynthesis in proximal humeral fractures

Cited by 11 publications

References 23 publications

Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely – A Retrospective Study

Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely – A Retrospective Study

Das schulterspezifische Outcome nach proximaler Humerusfraktur hat Einfluss auf die mittelfristige allgemeine Lebensqualität

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach

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