PHILOS Plate Plus Oblique Insertion of Autologous Fibula for 2-Part Proximal Humerus Fractures With Medial Column Disruption: A Retrospective Study

Abstract

Introduction: The aim of this retrospective study was to evaluate the outcomes of older patients with 2-part proximal humerus fractures (PHFs) with medial column disruption stabilized using a proximal humeral internal locking system (PHILOS) plate plus oblique insertion of autologous fibula as a primary procedure. Materials and Methods: Data involving 112 patients (112 shoulders) sustaining 2-part PHFs with medial column disruption treated with PHILOS plate plus oblique insertion of autologous fibula as a primary procedure during 2012-2019 were identified. The median follow-up was 36 months (range: 11.2-43.5 months). The primary endpoint was the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores. The secondary endpoint was the main orthopedic complication rate. Results: The median Constant and ASES scores were 78 (range, 52-95) and 77 (range, 62-96) at the final follow-up, respectively. The main orthopedic complication rate was 10.7% (12/112). Twelve orthopedic complications in 8 patients were detected, and they involved loss of reduction, varus collapse, aseptic loosening, mal-union, revision, and intolerable shoulder pain. Of these complications, 3 (2.6%) involved loss of reduction, 2 (1.7%) involved varus collapse, 3 (2.6%) involved aseptic loosening, 1 (0.8%) involved mal-union, 2 (1.7%) required revision surgery, and 1 (0.8%) presented intolerable shoulder pain. Conclusion: PHILOS plate plus oblique insertion of autologous fibula as a primary procedure may yield good functional outcomes and a low rate of the main orthopedic complications.

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

“…The functional outcomes in patients included in the present study experiencing a PHILOS plate plus an allogeneic fibula inserted obliquely were consistent with a recent study 21 of 112 patients with displaced 2-part PHFs experiencing PHILOS plate plus oblique insertion of autologous fibula. 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.…”

“… 26 , 27 In the current study, the rate of the loss of reduction was 4.7% (4/86) and the varus collapse failed to be detected. There is, as far as we know, only 1 prior study involving an allogeneic fibula inserted obliquely, this study 21 evaluating the outcomes according to the Constant and ASES scores and the rate of key orthopaedic complications in 112 patients with 2-part PHFs treated with a PHILOS plate plus oblique insertion of autologous fibula reported that the rate of loss of reduction was 2.6% (3/112), which is consistent with our result. A retrospective study 26 of 36 patients with unstable PHFs with medial column disruption reported a 5.6% rate of varus collapse.…”

Increasing the angle between caudal screw and the transverse plane may aggravate the risk of femoral head necrosis by deteriorating the fixation stability in patients with femoral neck fracture

“…In this study, positive screw angle triggers poor fixation stability and a higher risk of femoral head necrosis, this may root in the limit screw distribution in the femoral head. Specifically, compared to the traditional locking plate, proximal humerus models fixed by the PHILOS plate present better stability [ 13 , 14 ]. Biomechanical research present that the abduction angulation of screw insertion cause a wider screw distribution in the humerus head, which may be an important reason for better angular stability [ 38 , 39 ].…”

“…Changes in the screw insertion angle were an important factor affecting fixation stability [ 11 , 12 ]. Moreover, biomechanical studies on proximal humeral fracture and vertebral burst fracture fixations proved that the cross screw configuration strategy could effectively optimize instant postoperative angular stability [ 13 , 14 ]. The biomechanical significance of cross-angle cannulated screws has also been investigated.…”