Minimally invasive plate osteosynthesis with PHILOS plate for proximal humerus fractures

Abstract

Objectives: The aim of the present study was to evaluate results, including clinical and radiologicaloutcomes and number of complications, following minimally invasive plate osteosynthesis (MIPO) ofproximal humerus fractures, using the PHILOS® proximal humerus internal locking system (SynthesHolding AG, Solothurn, Switzerland).Methods: Retrospectively evaluated were 31 patients treated with MIPO (12 male, 19 female; averageage: 58.4 years). Four patients had 2-part fractures, 14 patients had 3-part fractures, and 13 patients had4-part fractures, according to Neer classiŞcation. Healing, complications, and head-shaft angle (HSA)were radiographically evaluated. Clinical outcomes were assessed at 1-year follow-up with Constantscore.Results: Average Constant scores for fractured and normal shoulders were 73.2± 10.9 and 84.8 ± 5.1,respectively. Varus progression, fracture type, and age had no signiŞcant effect on functional outcome.Average postoperative and follow-up HSA's were 130.80± 7.70 and 128.80 ± 10.00, respectively. SigniŞcant varus progression was observed during follow-up (p ¼ 0.01). Varus progression was moreprominent in patients with postoperative HSA< 130(p< 0.001). Inferomedial calcar screw usage,fracture type, and age had no signiŞcant effect on varus progression. Complications included 2 implantfailures, 1 case of avascular necrosis (AVN), 1 primary screw cut-out, 1 axillary nerve injury, and 1 radialnerve injury (22.6% overall).Conclusion: MIPO is a safe and effective option for the treatment of proximal humerus fractures, withgood functional recovery and fewer complications, which are typically technique dependent. Reductionmay be difŞcult, resulting in varus progression. Another disadvantage is risk of axillary nerve injury.Careful surgical technique and correct implant selection is important in the prevention of nerve injury.Level of evidence: Level IV, Therapeutic study.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)