Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Abstract

Purpose The aim of this study was to evaluate clinical outcomes and complications following minimally invasive plate osteosynthesis (MIPO) with the proximal humeral internal locking system (PHILOS) for treating proximal humeral shaft fracture through the deltopectoral approach. Methods Between November 2008 and March 2010, 74 patients with unilateral proximal humeral shaft fractures were treated using the MIPO technique with the PHILOS through the deltopectoral approach. Patients received an average follow-up of 16.9 (range, 12-24) months, and the final follow-up included anteroposterior and lateral imaging and recording of postoperative complications. The Constant-Murley shoulder score was used to evaluate function. Results No intraoperative complications occurred. Postoperative complications included subacromial impingement in four patients. There was no deep infection, neurovascular damage, breakage or implant loosening. All fractures united in an average time of 17.4 (15-25) weeks. In terms of function, the Constant-Murley score was 85.8 points on average (range, 67-100). The range of motion of the involved shoulder was satisfactory, and pain-free in 83.8 % of patients. Conclusions Using the MIPO technique with the PHILOS through the deltopectoral approach is a valid and safe method of treating proximal humeral shaft fractures.

Novel computer-assisted preoperative planning system for humeral shaft fractures: report of 43 cases

“…Therefore, we can easily and quickly select suitable implants for treating humeral shaft fractures. The PHILOS plate, a mono‐locking compression plate, has proven to be most suitable for fractures extending into the proximal part of the humerus . For pure shaft fractures, the LCP is preferable because the screws have a larger diameter .…”

“…However, ORIF is associated with extensive soft tissue dissection and bears the risk of iatrogenic injury to the radial nerve . Also, minimally invasive plate osteosynthesis (MIPO) with locking plate systems has become practicable, combining the benefits of plate fixation and biological osteosynthesis and allowing early function after treatment . Minimally invasive surgical procedures minimize local soft tissue trauma, reduce postoperative pain, create fewer periarticular adhesions, and result in better joint function.…”

“…However, MIPO techniques are generally considered difficult to perform, and the reduction is often less than perfect. The most common complications associated with MIPO techniques include malunion, iatrogenic radial nerve injury (IRNI), infection, and fixation material problems . Therefore, achieving a good clinical outcome with fracture healing is difficult in patients with humeral shaft fractures, particularly elderly patients.…”

Can we decipher indications and outcomes of the PHILOS plate for fractures of the proximal humerus?

“…Sir, I read with interest the recent article by Zhou et al [1] describing the outcome of the proximal humeral internal locking system (PHILOS) plate in 74 patients. However, I am still unsure of the exact indications for the plate.…”

Reply to: Can we decipher the indications and outcome of the PHILOS plate for fractures of the proximal humerus?

“…Therefore, internal fixation using a plating technique currently seems reasonable and indispensable for proximal humeral fractures in the elderly. Improvement of orthopaedic implants and surgical techniques (such as minimally invasive surgery) continues to be attractive [5]. It is also valuable to reveal and avoid potential risk factors to decrease post-operative complications.…”