EFFECTIVENESS OF PROXIMAL HUMERAL INTERNAL LOCKING SYSTEM PLATE FOR PROXIMAL HUMERUS FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QINBengang , LIPing ^Δ , YANGJiantao , YANGYi , FUGuo , WANGHonggang , QIJian , ZHUQingtang ,  GULiqiang

Department of Microsurgery, Orthopaedic Trauma & Hand Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510080, P. R. China;

Corresponding author：

GULiqiang, Email: guliqiang1963@aliyun.com

Keywords：

Proximal humerus fracture; Proximal humeral internal locking system plate; Internal fixation

DOI：

10.7507/1002-1892.20160245

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Objective To analyze the effectiveness of proximal humeral internal locking system (Philos) plate for proximal humerus fracture. Methods Thirty-three patients with proximal humerus fracture were treated with open reduction and internal fixation with Philos plate between January 2009 and January 2014. There were 19 males and 14 females, aged 23-89 years (mean, 56.6 years). The left side was involved in 15 cases, and the right side in 18 cases. The injury causes included falling in 20 cases and traffic accident in 13 cases. All cases received X-ray and CT scan and three-dimensional reconstruction before operation. According to the Neer classification, 8 cases were rated as two-part fractures, 15 cases as three-part fractures, and 10 cases as four-part fractures. The interval time between injury and surgery was 1-7 days (mean, 3.67 days). Postoperative functional outcome was evaluated using the Constant-Murley score. Results Infection and liquefaction occurred in 2 cases respectively, which was cured after corresponding treatment; primary healing of wound was obtained in the other 29 cases. Five patients had shoulder pain. The patients were followed up 11-47 months (mean, 33 months). The mean time of fracture union was 7.5 months (range, 5-9 months) on the X-ray films. Humeral head necrosis occurred in 2 patients with Neer four-part fractures, and internal fixation failure occurred in 3 patients (2 screw broken and 1 plate broken) with four-part fractures (2 cases) and three-part fractures (1 case), which was cured after conservative treatment. At last follow-up, the mean Constant-Murley score was 70.5 (range, 42-90); the results were excellent in 3 cases, good in 21 cases, moderate in 6 cases, and poor in 3 cases. Conclusion Satisfactory results can be expected for proximal humeral fracture by using of the proximal humeral internal locking system plate based on strict indication and early rehabilitation training.

Citation： QIN Bengang, LI Ping, YANG Jiantao, YANG Yi, FU Guo, WANG Honggang, QI Jian, ZHU Qingtang, GU Liqiang. EFFECTIVENESS OF PROXIMAL HUMERAL INTERNAL LOCKING SYSTEM PLATE FOR PROXIMAL HUMERUS FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(10): 1195-1199. doi: 10.7507/1002-1892.20160245 Copy

1.	Helmy N, Hintermann B. New trends in the treatment of proximal humerus fractures. Clin Orthop Relat Res, 2006, 442:100-108.
2.	Calvo E, Morcillo D, Foruria AM, et al. Nondisplaced proximal humeral fractures:high incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception. J Shoulder Elbow Surg, 2011, 20(5):795-801.
3.	姜保国, 陈建海. 肱骨近端骨折的治疗. 北京大学学报(医学版), 2012, 44(6):821-823.
4.	Gavaskar AS, Chowdary N, Abraham S. Complex proximal humerus fractures treated with locked plating utilizing an extended deltoid split approach with a shoulder strap incision. J Orthop Trauma, 2013, 27(2):73-76.
5.	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214):160-164.
6.	Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate:a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand, 2004, 75(6):741-745.
7.	朱乃锋, 陈云丰. 肱骨近端骨折内固定物稳定性的生物力学分析. 中国修复重建外科杂志, 2010, 24(12):1459-1462.
8.	Sproul RC, Iyengar JJ, Devcic Z, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury, 2011, 42(4):408-413.
9.	Königshausen M, Kübler L, Godry H, et al. Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. A reliable system? Injury, 2012, 43(2):223-231.
10.	Bahrs C, Kühle L, Blumenstock G, et al. Which parameters affect medium-to long-term results after angular stable plate fixation for proximal humeral fractures? J Shoulder Elbow Surg, 2015, 24(5):727-732.
11.	Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus:A retrospective analysis of 82 cases treated with the Philos locking plate. Injury, 2014, 45 Suppl 6:S43-48.
12.	Björkenheim JM, Pajarinen J, Savolainen V. Intemal ruction of proximal humeral fractures with a locking compression plate:a retrospecrive evaluation of 72 patients followed for a minimum of l year. Acta Orthop Scand, 2004, 75(6):741-745.
13.	Ye T, Wang L, Zhuang C, et al. Functional outcomes following locking plate fixation of complex proximal humeral fractures. Orthopedics, 2013, 36(6):e715-722.
14.	付中国, 邓磊, 白露, 等. 肱骨近端骨折锁定接骨板治疗术后并发症分析. 北京大学学报(医学版), 2011, 43(5):666-670.
15.	Konrad G, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 1:85-95.
16.	Ruchholtz S, Hauk C, Lewan U, et al. Minimally invasive polyaxial locking plate fixation of proximal humeral fractures:a prospective study. J Trauma, 2011, 71(6):1737-1744.
17.	Hertel R, Hempfing A, Stiehler M, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg, 2004, 13(4):427-433.
18.	Sturzenegger M, Fornaro E, Jakob RP. Results of surgical treatment of multifragmented fractures of the humeral head. Arch Orthop Trauma Surg, 1982, 100(4):249-259.
19.	Wijgman AJ, Roolker W, Patt TW, et al. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg (Am), 2002, 84-A(11):1919-1925.
20.	Jost B, Spross C, Grehn H, et al. Locking plate fixation of fractures of the proximal humerus:analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg, 2013, 22(4):542-549.
21.	Brunner F, Sommer C, Bahrs C, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate:a prospective multicenter analysis. J Orthop Trauma, 2009, 23(3):163-172.
22.	Vachtsevanos L, Hayden L, Desai AS, et al. Management of proximal humerus fractures in adults. World J Orthop, 2014, 5(5):685-693.
23.	Hirschmann MT, Fallegger B, Amsler F, et al. Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma, 2011, 25(5):286-293.
24.	曾浪清, 陈云丰, 王磊, 等. 锁定钢板治疗Neer三部分及四部分肱骨近端骨折疗效. 中国修复重建外科杂志, 2012, 26(12):1469-1472.

1. Helmy N, Hintermann B. New trends in the treatment of proximal humerus fractures. Clin Orthop Relat Res, 2006, 442:100-108.
2. Calvo E, Morcillo D, Foruria AM, et al. Nondisplaced proximal humeral fractures:high incidence among outpatient-treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception. J Shoulder Elbow Surg, 2011, 20(5):795-801.
3. 姜保国, 陈建海. 肱骨近端骨折的治疗. 北京大学学报(医学版), 2012, 44(6):821-823.
4. Gavaskar AS, Chowdary N, Abraham S. Complex proximal humerus fractures treated with locked plating utilizing an extended deltoid split approach with a shoulder strap incision. J Orthop Trauma, 2013, 27(2):73-76.
5. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214):160-164.
6. Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate:a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand, 2004, 75(6):741-745.
7. 朱乃锋, 陈云丰. 肱骨近端骨折内固定物稳定性的生物力学分析. 中国修复重建外科杂志, 2010, 24(12):1459-1462.
8. Sproul RC, Iyengar JJ, Devcic Z, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury, 2011, 42(4):408-413.
9. Königshausen M, Kübler L, Godry H, et al. Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. A reliable system? Injury, 2012, 43(2):223-231.
10. Bahrs C, Kühle L, Blumenstock G, et al. Which parameters affect medium-to long-term results after angular stable plate fixation for proximal humeral fractures? J Shoulder Elbow Surg, 2015, 24(5):727-732.
11. Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus:A retrospective analysis of 82 cases treated with the Philos locking plate. Injury, 2014, 45 Suppl 6:S43-48.
12. Björkenheim JM, Pajarinen J, Savolainen V. Intemal ruction of proximal humeral fractures with a locking compression plate:a retrospecrive evaluation of 72 patients followed for a minimum of l year. Acta Orthop Scand, 2004, 75(6):741-745.
13. Ye T, Wang L, Zhuang C, et al. Functional outcomes following locking plate fixation of complex proximal humeral fractures. Orthopedics, 2013, 36(6):e715-722.
14. 付中国, 邓磊, 白露, 等. 肱骨近端骨折锁定接骨板治疗术后并发症分析. 北京大学学报(医学版), 2011, 43(5):666-670.
15. Konrad G, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 1:85-95.
16. Ruchholtz S, Hauk C, Lewan U, et al. Minimally invasive polyaxial locking plate fixation of proximal humeral fractures:a prospective study. J Trauma, 2011, 71(6):1737-1744.
17. Hertel R, Hempfing A, Stiehler M, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg, 2004, 13(4):427-433.
18. Sturzenegger M, Fornaro E, Jakob RP. Results of surgical treatment of multifragmented fractures of the humeral head. Arch Orthop Trauma Surg, 1982, 100(4):249-259.
19. Wijgman AJ, Roolker W, Patt TW, et al. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg (Am), 2002, 84-A(11):1919-1925.
20. Jost B, Spross C, Grehn H, et al. Locking plate fixation of fractures of the proximal humerus:analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg, 2013, 22(4):542-549.
21. Brunner F, Sommer C, Bahrs C, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate:a prospective multicenter analysis. J Orthop Trauma, 2009, 23(3):163-172.
22. Vachtsevanos L, Hayden L, Desai AS, et al. Management of proximal humerus fractures in adults. World J Orthop, 2014, 5(5):685-693.
23. Hirschmann MT, Fallegger B, Amsler F, et al. Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma, 2011, 25(5):286-293.
24. 曾浪清, 陈云丰, 王磊, 等. 锁定钢板治疗Neer三部分及四部分肱骨近端骨折疗效. 中国修复重建外科杂志, 2012, 26(12):1469-1472.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF PROXIMAL HUMERAL INTERNAL LOCKING SYSTEM PLATE FOR PROXIMAL HUMERUS FRACTURES

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