Complex Proximal Humeral Fracture Fixation with PHILOS Plate using Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) Technique: A Series of 30 Patients

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

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.

Efficacy of Intramedullary Nailing in the Treatment of Comminuted Proximal Humeral Fractures and Its Influence on Shoulder Joint Function Recovery

In this paper, we have aimed to elucidate the therapeutic effect of intramedullary nailing (IMN) in treating comminuted proximal humeral fractures (CPHFs) and its influence on the recovery of shoulder joint function. For this purpose, 60 cases with CPHFs were selected, particularly from January 2020 to October 2021. In these cases, 28 cases were treated with a locking proximal humeral plate (LPHP) and assigned to the control (Con) group and the remaining 32 patients were treated with IMN and included in the research (Res) group. The therapeutic effect, surgical indicators, total complications, visual analogue scale (VAS) score, and postoperative shoulder joint function score were compared between the two arms. We observed that compared with the Con group, the effective rate in the Res group was higher while the operation time, intraoperative blood loss, and fracture healing time were shorter, the overall complication rate and VAS score were lower, and the postoperative shoulder joint function score was higher, all with statistical significance. The above results indicate that IMN is effective and safe in the treatment of CPHFs, which can validly reduce the discomfort of patients and facilitate the recovery of shoulder joint function.

Comparison of the Effects of Proximal Humeral Internal Locking System (PHILOS) Alone and PHILOS Combined with Fibular Allograft in the Treatment of Neer Three- or Four-part Proximal Humerus Fractures in the Elderly

Objective

To compare and analyze the clinical outcomes of the proximal humeral internal locking system (PHILOS) alone and the PHILOS combined with fibular allograft in the treatment of Neer three‐ and four‐part proximal humerus fractures (PHF) in the elderly.

Methods

From January 2014 to January 2018, a total of 42 elderly patients with Neer three‐ or four‐part PHF admitted to our hospital were randomly divided into observation group and control group, with 21 patients in each group. The observation group was treated with the PHILOS combined with fibular allograft. The control group was treated with the PHILOS alone. Perioperative parameters and fracture classification were recorded in the two groups. Function results were assessed by Visual Analog Scale (VAS), Constant‐Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, and the Disability of Arm‐Shoulder‐Hand (DASH) score. Radiological results were evaluated using the neck‐shaft angle (NSA) and humeral head height (HHH), and complications were also recorded in each group.

Results

There were no significant differences between the two groups in terms of preoperative status, age, gender, cause of trauma, fracture site, and fracture classification. The average follow‐up time was 12 months. At the last follow‐up, the VAS and DASH observation groups were lower than the control group, and there was significant difference between the two groups (P < 0.05). The CMS and ASES were higher in the observation group than the control group, and there was significant difference between the two groups (P < 0.05). The mean difference in the NSA and HHH were lower in the observation group than the control group, and there was a significant difference between the two groups (P < 0.05). There was one postoperative complication in the observation group, which was humeral head avascular necrosis (AVN). There were seven postoperative complications in the control group, including three cases of humeral head collapse and three cases of screw cutout and one case of humeral head AVN. The incidence of postoperative complications in the observation group was significantly lower than the control group (P < 0.05), there was a significant difference between the two groups.

Conclusions

For Neer three‐ or four‐part PHF in the elderly patients, PHILOS fixation with fibular allograft shows satisfactory short‐term results with respect to humeral head support and maintenance of reduction, and may reduce the incidence of complications associated with fixation using a PHILOS alone.