Osteosynthesis of Proximal Humeral Fractures with the Fixed Angle PHILOS-plate

Klitscher, Daniela; Blum, Jochen; Andreas, Dominik; Hessmann, M.; Kuechle, R.; Prel, Jean‐Baptist du; Rommens, Pol Maria

doi:10.1007/s00068-007-7093-6

Cited by 12 publications

(19 citation statements)

References 31 publications

(63 reference statements)

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“…The average duration of the interval between the injury and time of surgery was 3.25 days whereas a study by Vijay et al; found the average time lag to be 6.24 days whereas Resch et al have found the interval between 2 to 10 days. 18,19 The average time for the radiological union in the present study was 13.5 weeks it was in accordance to similar studies done by Ebraheim et al, Klitscher et al Kilic et al [20][21][22] In the present study, 66.67% had excellent results and 16.67% had good results. Hirschmann et al, in their study with 64 patients with a minimum follow-up of four years, treated with locking plate, and have reported 75% excellent and good results.…”

Section: Discussionsupporting

confidence: 91%

A study of proximal humerus fractures treated by PHILOS plating in a tertiary care hospital

Srikanth¹,

Reddy²,

Omkarnath³

2019

Int J Res Orthop

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Background: Proximal humeral fractures are commonly presented in the orthopedic practice. The usual method of treatment was conservative in the past. However, the results and functional outcomes were not good. With the development of PHILOS locking plates, the functional outcomes are known to be improved. We in the present study tried to evaluate the functional outcomes of proximal humerus fractures treated with PHILOS plates.Methods: This prospective study was conducted in all Adult patients with closed two-part and three-part fractures of the proximal humerus, those who have reported within a week of the injury were included in the study. A total of n=30 patients were included in the study based on the inclusion and exclusion criteria. A standard surgical approach with PHILOS plate was used and patients were followed up for 19 to 24 months.Results: n=30 patients out of which n=16 (53.33%) were males and n=14 (46.67%) were females. The most common age group involved in the fractures was 31-35 years n=9 (30%) of the patients. Most of the patients n=21 (70%) were having Neer's two-part fractures and three-part fractures were found in n=6 (20%) and four part in n=3 (10%). The overall results in the study were 66.67% of patients had excellent results and 16.67% had good results and 10% had poor results.Conclusions: PHILOS locking plates is a better treatment option for fractures of proximal humerus especially in cases of poor bone quality and comminuted fractures.

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Section: Discussionsupporting

confidence: 91%

A study of proximal humerus fractures treated by PHILOS plating in a tertiary care hospital

Srikanth¹,

Reddy²,

Omkarnath³

2019

Int J Res Orthop

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“…The mean neck/shaft angle after reduction was 133.7°and was never seen to change during later follow-ups. Examining all the angle values, we found 28 cases with consolidation at angles between 120°and 145°, which we considered within normal limits according to literature reports [2,7]. One patient (case 17) had an angle of 115°, a less than optimal reduction of tubercles, and a Constant score (CS) of 46.…”

Section: Surgical Techniquementioning

confidence: 98%

“…One last problem is vascularisation of the head, which is at risk, especially in 4-part fractures: the metaphyseal hinge distance is often less than 8 mm, and this is significant, due to interruption of the anterior circumflex artery, considered to be the most important for vascularisation of the humeral head [1,2], although several authors give more importance to the posterior circumflex artery [3]. We therefore believe that 3-part fractures have favourable prognosis and should be clearly distinguished, in assessments, from those with 4 parts.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Before applying the screws, the wires were first fixed to the major and lesser tubercles, passed through the plate holes and then pulled taut. Osteosynthesis was completed with angular screws, with the LCP [4] in the first 14 patients and the Philos [2,[5][6][7][8][9][10][11][12][13] plate in the remaining 16. Both plates involve the use of an aiming device to set the proximal screws in the correct direction in cases of osteopenic bone.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Displaced proximal fractures of the humerus, with 3 or 4 fragments according to Neer, present several serious problems for orthopaedic surgeons: complexity of proper reduction; precarious purchase of screws in the spongy bone of the head of the humerus, which has a very low bone stock, especially in postmenopausal women; and risk of necrosis of the head, due to terminal vascularisation [1][2][3]. In this study, we examined a group of patients with displaced fractures of the proximal humerus, in 3 or 4 parts, operated with insertion of LCP or Philos plates and angular screws to improve stability.…”

Section: Introductionmentioning

confidence: 99%

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Plating of proximal fracture of the humerus: a study of 30 cases

2011

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In recent years, plate osteosynthesis with angular stable implants is frequently used for severely displaced three- and four-part proximal humeral fractures. The aim of this study is to evaluate early results of these fractures treated with insertion of LCP or Philos plates. We present results in 30 cases of proximal humeral fractures, 17 with 3 parts according to Neer and 13 with 4 parts, treated with Locking Compression Plates (LCP, 14 cases) and Philos plates (16) by the deltopectoral approach. Patients were checked with standard X-rays and clinical evaluation, according to the Constant-Murley shoulder score, Individual Constant score and Relative Constant score. Mean follow-up time was 21 months (range 6-42 months). The mean Constant-Murley shoulder scores were Pain 10.6 (3-15), Activities of Daily Living 15.3 (2-20), Range of Motion 26.8 (12-40) and Power 10.3 (3-25) and Total 63 (25-97). The Individual Constant score was 68.6% (27-98%) and the Relative Constant score 85.4% (36-130%). Fractures in 3 parts (of the surgical or anatomic humeral neck and major tubercle) had a mean Constant score of 69.1 (17 cases), but this fell to 55 (13 cases) in those in 4 parts (neck, major and lesser tubercles). Late necrosis of the humeral head occurred in two cases, both with 4-part breaks. We thus believe that 3-part fractures, in which both reduction and stable osteosynthesis are easier, show favourable prognosis and should be clearly distinguished from 4-part ones during assessments. The deltopectoral approach offers good exposure and is especially recommended in 4-part fractures, also because it provides a good view of the lesser tubercle. The osteosynthesis must be stable if early mobilisation of the shoulder and proper recovery of range of motion are to be achieved. As well as reduction and stabilisation of the tubercles, it is also important to restore the neck/shaft angle and stabilise it with oblique screws fitting the plate to avoid varus malposition.

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Treatment of proximal humeral fractures with reverse shoulder arthroplasty in elderly patients

et al. 2014

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Total reverse prostheses are more invasive because they also compromise the glenoid surface of the scapula, but they do offer good stability, even in cases of damage to the rotator cuff. Reverse prostheses have great advantages as regards to ROM, allowing functional recovery, which is good in cases with re-insertion of tuberosities, and acceptable in cases when tuberosities are not re-inserted or resorbed. In our cases, the first 3 reverse prostheses lasted 10, 8.3 and 7.3 years, and we believe that they will become increasingly long-lived, so that applying them in cases of complex fractures becomes more feasible. We prefer the deltopectoral approach because it can reduce and stabilize possible intra-operative diaphyseal fractures. Possible scapular notching must be foreseen when inserting the glenosphere. We had eight cases (24.2 %), of which four were Nerot grade 1 and four were grade 2. Applying the Kirschner wire in an infero-anterior position allows the glenosphere to be lowered with a tilt of 10°. Reverse prostheses are suitable for 3- or 4-part complex proximal humeral fractures in patients over 65. Prolonged physiokinesitherapy is essential.

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Osteosynthesis of Proximal Humeral Fractures with the Fixed Angle PHILOS-plate

Cited by 12 publications

References 31 publications

A study of proximal humerus fractures treated by PHILOS plating in a tertiary care hospital

A study of proximal humerus fractures treated by PHILOS plating in a tertiary care hospital

Plating of proximal fracture of the humerus: a study of 30 cases

Treatment of proximal humeral fractures with reverse shoulder arthroplasty in elderly patients

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