Proximal Humeral Internal Locking System Research Articles

Reversed proximal humeral internal locking system (PHILOS) plate for distal humeral shaft fractures through an Anterolateral Approach

Reversed proximal humeral internal locking system (PHILOS) plate for distal humeral shaft fractures through an Anterolateral Approach

Novel calcaneal plate versus traditional philos plate for treating split fractures of humeral greater tuberosity.

To compare the effect of two internal fixation methods of calcaneal plate fixation and Philos plate fixation in treating split fractures of humeral greater tuberosity. A total of 37 patients with split fractures of humeral greater tuberosity were retrospectively analyzed from September 2016 to April 2021. Enrolled patients were divided into Group A (calcaneal anatomical locking plates), and Group B [Proximal Humeral Internal Locking System (PHILOS)]. The demographics, injury-related variables, surgery-related variables, Constant-Murley score, and postoperative complication between the two groups were compared. There were 16 in Group A and 21 in Group B. Fracture union was achieved in all patients, with an average of 11.9 months. The mean length of incision was significantly different between groups (Group A, 6.16 cm ± 1.07 cm; Group B, 9.09 cm ± 1.30 cm, p < 0.05). Significant difference was observed by comparing bleeding loss between Group A and Group B (Group A, 45.41 ± 11.19 ml; Group B, 106.06 ± 11.12 ml, p < 0.05). After 6 months of treatment, the average Constant-Murley score of Group A was significantly higher than that of Group B (p < 0.05). In terms of operation, no significant difference was observed between groups. In addition, two patients had shoulder impingement syndrome in Group B, and none in Group A. Calcaneal anatomical locking plate fixation is superior to Philos plate fixation in surgical trauma and bleeding loss. Our study provides an alternative technique for treating split fractures of humeral greater tuberosity.

Comparison of the ALPS and PHILOS plating systems in proximal humeral fracture fixation – a retrospective study

BackgroundOpen reduction and plate osteosynthesis are considered as a successful technique for the treatment of proximal humerus fracture (PHF) despite high complication rates. The objective of our study was to review the clinical outcome and complications of the Anatomic Locking Plate System (ALPS) and compare it to the Proximal Humeral Internal Locking System (PHILOS). Our hypothesis was that ranges of motion (ROM) were superior and complication rates were lower with ALPS.MethodsTwenty patients treated with ALPS for PHF were retrospectively compared to 27 patients treated with PHILOS. Union, ROM and complications were clinically and radiologically assessed at 6 weeks, 3, 6, 12 and 18–24 months post-operatively.ResultsMean age was 52 ± 14 in the ALPS group and 58 ± 13 in the PHILOS group. Last follow-ups were conducted at a mean of 20.6 ± 4.8 months. Mean shoulder abduction was superior with ALPS by 14° (p-value = 0.036), 15° (p-value = 0.049), and 15° (p-value = 0.049) at 3, 6, and 12 months respectively. Mean shoulder external rotation was superior with ALPS by 11° (p-value = 0.032), 15° (p-value = 0.010) and 12° (p-value = 0.016) at 6 weeks, 3 and 6 months respectively. At the end of the follow-up, ROM remained better with ALPS, but not significantly. Complication rates over 21 months reached 20% with ALPS and 48% with PHILOS (p-value = 0.045). Implant removal rates reached 10% with ALPS and 37% with PHILOS (p-value = 0.036). Avascular necrosis was the only cause for hardware removal in the ALPS group.ConclusionThe ALPS group showed better clinical outcomes with faster recovery in abduction and external rotation, although no difference in ROM remained after 21 months. Additionally, the complications rate was lower at last follow up. In our experience, the ALPS plating system is an effective management option in some PHF.

Treatment of four-part proximal humerus fractures with depressed humeral head collapse using strut allograft with locking plates

To evaluate the clinical outcomes of allogeneic femoral head as strut allograft combined with proximal humeral internal locking system (PHILOS) in the treatment of proximal humeral Neer grade Ⅳ fracture with humeral head collapse. From January 2018 to November 2020, 18 patients with Neer grade Ⅳ fracture with humeral head collapse were treated with strut allograft with PHILOS, including 4 males and 14 females, aged from 55 to 78 years old, with an average of (68.11±7.20) years old. The operation time, intraoperative bleeding, postoperative drainage volume, fracture healing time, neck-shaft angle and the height of the humeral head, failure of internal fixation the shoulder function at the last follow-up was assessed using Neer's scoring system. All 18 patients were followed up, and the duration ranged from 10 to 12 months, with an average of (11.08±0.65) months. The operation time was (66.44±5.06) min, the intraoperative bleeding volume was (206.67±36.14) ml, the postoperative drainage volume was (76.11±9.63) ml, and the fracture healing time was (17.28±3.92) weeks. At the last follow-up, the degree of loss of neck-shaft angle was (5.44±0.86) ° and the loss of the height of humeral head was (1.43±0.27) mm. All 18 patients had healing without complications such as fracture, withdrawal, penetration of internal fixation and necrosis of humeral head. According to Neer's evaluation standard, the total score was (89.61±5.60), 10 cases got an excellent result, 6 good, 2 fair. Allogeneic femoral head combined with PHILOS is an appropriate treatment for the four-part proximal humerus fractures with humeral head collapse, exhibiting good clinic outcome.

Clinical and Radiological Outcome of Dual Plating for Proximal Humerus Fractures.

Introduction Proximal humerus fractures account for approximately 4%-5% of all fractures. It accounts for approximately 45% of all humeral fractures. Proximal humerus fractures which are mostly stable or minimally displaced fractures are usually managed non-operatively with good outcomes. Displaced or unstable fractures may require reduction and stabilization. For proximal humerus fractures, conservative treatments often result in stiffness and malunion of the shoulder. In comminuted proximal humerus fracturesthe use of a proximal humeral internal locking system (PHILOS) only does not provide the required stable fixation which usually leads to complications such as varus collapse,malunion, anterior-posterior angulation, screw cutout, metal failure and nonunionand thusopen reduction and internal fixation with dual plating are recommended for proximal humerus fractures. Material and methods The Institutional Ethics Committee of Dr. D. Y. Patil Vidyapeeth in Pune approved this prospective study. We included a sample size of 52 patients and conducted a study on these patients who were admitted under the Orthopedics department at Dr. D. Y. Patil Medical College and Hospital, Pune. Results In this study, 52 patients were treated with dual plating for proximal humerus fracture, an additional plate is used along with PHILOS. In our study, the majority of the study population belonged to > 50 years (34.6%), followed by 41-50 years (26.9%), 31-40 years (23.1%), and 21-30 years (15.4%). The mean age of the patient was 53.7 years including 33 male and 19 female patients. The majority of the patient in the study included was with RTA 40 patients and 12 patients with a history of falls from height. The fracture was classified using Neers classification, Neer type 2 fracture (23.1%), Neer type 3 fracture (46.2%), and Neer type 4 fracture (30.7%). In the current study, the mean DASH score at Baseline was 58.88±6.29, at three months was 36.23±5.05 and at six months was 31.85±4.16. The mean DASH score decreased significantly from baseline to three months to 6 months. As per the Paavolainen method, it was good among 40 (76.9%) and fair among 10 (19.2%), and poor among two (3.8%) cases. Out of 52 patients, we found varus collapse in immediate postop x-ray in two patient and screw protrusion in the glenohumeral joint in one patient. Conclusion Satisfactory clinical and radiological outcomes were noted. This dual mechanism prevents varus displacement of the proximal fragment, and as a result, it provides a good functional outcome with dual plates in proximal humerus fractures.

A STUDY ON, TREATMENT OF PROXIMAL HUMERUS FRACTURES USING PHILOS PLATE IN A TERTIARY CARE HOSPITAL.

Fractures of proximal humerus is still unsolved fractures in many ways.A wide variety of treatment modalities have been used for these fractures.The Proximal humeral internal locking system (PHILOS) plate xation provides greater angular stability than do conventional implants.The aim of the study is to assess the functional outcome of proximal humerus fractures treated with PHILOS plating.To recognize any associated complications.This was a prospective study conducted fron August 2020 to February 2021 in our hospital with 5-6 month follow up. We include skeletally matured patients with proximal humerus fractures with displacement &gt;1cm and varus angulation of &gt;45*.The outcome was assessed using Neer's scoring system and recorded before treatment and on follow up at 1st month, 2nd month, 4th month and 6th month. Fracture healing assessed by consecutive radiographs.As per Neer's classication system, there were (11.32%)1 part, (35.85%)2 part, (32.08%)3 part and (20.75%)4 part fractures. Average surgical duration was 90+\- 15min. Radiological union was seen at 12+\- 4 weeks.Among all the cases 13.2%cases had excellent results,69.8% had satisfactory results and 11.3% had unsatisfactory results.PHILOS plating has a good functional outcome for proximal humerus fractures in skeletally matured patients.

Additional cuff suture provides mechanical advantage for fixation of split-type greater tuberosity fracture of humerus

PurposeSplit type of greater tuberosity fracture has variety of surgical treatment options. This study aimed to compare the biomechanics property of additional cuff suture and other fracture fixation techniques. MethodsFifteen porcine humeri were categorized into three groups of fixation techniques those were proximal humeral internal locking system (PHILOS) plate with 2 cuff sutures, nonlocking (conventional, 3.5 mm) T-plate with 2 cuff sutures and T-plate with washer that had additional cuff suture (novel technique). Fracture was created by greater tuberosity osteotomy with 50˚ inclination to the line of surgical neck and then fixed with different prescribed techniques. Displacement of fracture site was measured with universal testing machine. The maximum forces to produce 3 mm, 5 mm of displacement and load to failure were recorded. ResultsThe average loads to reach 3 mm, 5 mm displacement and failure were 30.8 N, 45.4 N and 161 N for nonlocking T-plate; 76.6 N, 99.2 N and 144 N for PHILOS plate; 95.8 N, 120 N and 197 N for novel technique. The differences among three groups were significant in load to displacement at 3 and 5 mm (but not significant in load to failure). For load to reach 3- and 5-mm displacement, PHILOS plate and novel technique were significantly stronger than nonlocking T-plate (P < 0.05). For load to reach 3 and 5 mm displacement, novel technique was stronger than PHILOS plate but not significant (P > 0.05). For load to failure, novel technique was stronger than nonlocking plate and PHILOS plate but not significant (P < 0.05). ConclusionThe important factors affecting the strength of fracture fixation are type of plate and numbers of suture augmentation that tie to the plate. Fixation with additional cuff suture showed the superior biomechanics of load to reach 3 mm, 5 mm displacement with better load to failure compared with PHILOS plate and conventional T-plate alone.

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach: A prospective case-control study.

Background:The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach.Methods:This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients’ functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score.Results:A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12–21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation (P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups (P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group (P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group (P = .049).Conclusion:The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.

Comparison between anterior and posterior plating systems in extra-articular distal-third diaphyseal humeral fractures.

The ideal surgical treatment of extra-articular distal-third diaphyseal humeral fractures is controversial in terms of the surgical approach and plate position. The aim of this study was to compare the clinical and radiological outcomes between anterior and posterior plating methods for extra-articular distal-third diaphyseal humeral fractures. Twenty-four patients were treated with anterior plating with modified placement of the proximal humeral internal locking system (PHILOS) plate, and 22 patients were treated with posterior plating of the extra-articular distal humerus plate (EADHP). Patient demographics, the fracture configuration, the number of screws in the distal fragment, the operation time, and the time to union were analyzed. The range of elbow motion, Mayo elbow performance score (MEPS), plate-related symptoms, and complications were evaluated at the final follow-up. There were no statistically significant differences in the demographic data between the two groups. The mean operation time for anterior plating (108.2 ± 24.5min) was significantly shorter than that for posterior plating (144.2 ± 29.5minutes, p < 0.001). The average number of screws used in the distal humeral fragment was significantly higher with anterior plating (5.7 ± 0.7) than with posterior plating (4.8 ± 0.5, p < 0.001). No patients in the anterior plating group had plate-related symptoms, while 17 patients in the posterior plating group (77%) had discomfort or cosmetic problems related to the plate (p < 0.001). Plate removal was performed upon patient request in nine patients of the posterior plating (52.9%) and four (17%) in anterior plating (p = 0.040). Nonunion occurred in one patient who underwent anterior plating, and one patient who underwent posterior plating had post-operative radial nerve palsy. There were no significant differences in the MEPS or elbow range of motion between the two surgical methods. Both anterior and posterior plating provide satisfactory clinical and radiologic outcomes for extra-articular distal-third diaphyseal humeral fractures. Despite the satisfactory outcomes, however, posterior plating is highly associated with plate-related complaints, which might be one of the considerations when the surgical method is selected for extra-articular distal-third diaphyseal humeral fractures.

Modified use of the proximal humeral internal locking system (PHILOS) plate for distal femoral nonunions

PurposeNonunion is a common complication after a distal femoral fracture (DFF). Standard treatment consists of revision plating and/or bone grafting. Single lateral plating for a distal femoral nonunion can be insufficient in case of a persistent medial gap and compromised bone stock. Alternatively, dual plating can be used to treat a distal femoral nonunion, but to date there is no Gold standard. The aim of our study was to report our results after use of a minimally invasively placed proximal humeral internal locking system (Philos) plate as a medial buttress in the treatment of a distal femoral nonunion.MethodsFifteen adult patients with a distal femoral nonunion were prospectively entered in a trauma database and retrospectively assessed. All patients underwent a similar operation, which included removal of failed hardware, nonunion debridement, fixation with a lateral plate, and a medial Philos plate combined with bone grafting. Data collected included union rate, time to union, complications and functional outcome.ResultsIn twelve out of fifteen patients (80%), the fracture united after our index operation. Median time to union was 4.8 months (range 1.6–15). Three patients (20%) needed additional bone grafting surgery. One patient underwent a Judet quadricepsplasty.ConclusionThis study suggests that the Philos plate is a safe and effective adjunct as a medial buttress plate for distal femoral nonunions.

A new biomechanical classification system for split fractures of the humeral greater tuberosity: guidelines for surgical treatment

BackgroundSplit fractures of the humeral greater tuberosity (HGT) are common injuries. Although there are numerous surgical treatments for these fractures, no classification system combining clinical and biomechanical characteristics has been presented to guide the choice of fixation method.MethodsWe created a standardised fracture of the HGT in 24 formalin-fixed cadavers. Six were left as single-fragment fractures (Group A), six were further prepared to create single-fragment with medium size full-thickness rotator cuff tear (FT-RCT) fractures (Group B), six were cut to create multi-fragment fractures (Group C), and six were cut to create multi-fragment with FT-RCT fractures (Group D). Each specimen was fixed with a shortened proximal humeral internal locking system (PHILOS) plate. The fixed fractures were subjected to load and load-to-failure tests and the differences between groups analysed.ResultsThe mean load-to-failure values were significantly different between groups (Group A, 446.83 ± 38.98 N; Group B, 384.17 ± 36.15 N; Group C, 317.17 ± 23.32 N and Group D, 266.83 ± 37.65 N, P < 0.05). The load-to-failure values for fractures with a greater tuberosity displacement of 10 mm were significantly different between each group (Group A, 194.00 ± 29.23 N; Group B, 157.00 ± 29.97 N; Group C, 109.00 ± 17.64 N and Group D, 79.67.83 ± 15.50 N; P < 0.05). These findings indicate that fractures with a displacement of 10 mm have different characteristics and should be considered separately from other HGT fractures when deciding surgical treatment.ConclusionsBiomechanical classification of split fractures of the HGT is a reliable method of categorising these fractures in order to decide surgical treatment. Our findings and proposed system will be a useful to guide the choice of surgical technique for the treatment of fractures of the HGT.

TIBIAL MALUNION WITH ANGULAR DEFORMITY MANAGED WITH CORRECTIVE OSTEOTOMY AND PHILOS PLATING IN A 15-YEAR MALE - CASE REPORT AND REVIEW OF LITERATURE

Tibia and fibula shaft fracture are common among young and old, if they are not managed correctly, can be debilitating in long term. Management of these fractures depends on severity,stability, and pattern of fracture. Options can range from conservative management by plate to external fixation, especially in the case of an open fracture. Unfortunately, the ideal fixation option (commonly used plate or nail) implant is not always available in operation theatre, in such circumstances closed reduction if not properly maintained can lead to malunion, especially in young age when healing is very rapid and such malunion can lead to early induced arthritis or many other complications1. here we discuss a case of 15-year-old male with a left distal tibia and fibula malunited fracture 11 monthsold, who presented with complaints of pain and deformity over distal 1/3 rd of right lower leg, patient required open reduction and internal fixation with 4-holePHILOS (PROXIMAL HUMERAL INTERNAL LOCKING SYSTEM) plate for tibia andLCP(Locking Compression Plate) plate for fibula. We conclude that in cases of distal tibia and fibula malunion when managed with open reduction internal fixation with osteotomy with PHILOSplating for deformity correction gives good result.

Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty

IntroductionAdequate treatment for periprosthetic distal femur fractures is challenging because of various reasons, including severe osteoporosis and distal fragments that are too small or too distal. We have introduced a new surgical technique for dual plating of periprosthetic distal femur fractures following total knee arthroplasty (TKA) and determined the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with a dual locking compression plate (LCP).Materials and methodsBetween January 2010 and July 2019, 18 patients [mean age, 74.8 (68–89) years; average follow-up period, 14.8 (12–43) months] underwent MIPO with distal femoral LCP laterally and proximal humeral internal locking system (PHILOS) medially for periprosthetic distal femoral fractures following TKA. The minimum follow-up was 1 year. The clinical and radiological outcomes were assessed using the modified WOMAC scores, knee range of motion, time to callus formation, time to union, and complications of malunion, nonunion, and shortening.ResultsThe average time to union was 18.4 weeks (range, 10–51 weeks) and to callus formation was 7.8 weeks (range, 2–14 weeks). At the 1-year follow-up, the average JLETS was 37.6 (range, 24–53), average knee ROM was 110.3° (range, 80–135°), and average varus-valgus angles of the distal femur were 3.2° (range, −2.9–10.5°). No nonunion, broken plates, or implant failure occurred. Malunion occurred in three patients.ConclusionMIPO with dual LCP is a reliable method for stabilizing periprosthetic distal femoral fractures following TKA, with satisfactory bone union rates and low complication rates.

Functional outcomes in proximal humerus fractures: A prospective registry-based analysis.

The present study evaluated and compared functional outcomes of proximal humerus fractures of different categories and their management with different procedures. Data of this prospective cohort was obtained from the orthopaedic trauma registry at a tertiary care hospital for the period from June 2015 to October 2019. Sixty-eight adult patients with proximal humerus fracture were identified out of which 57 (84%) had been operated. Functional outcomes were assessed up to 12-month follow-ups and were compared with different treatment groups, fracture category, and between isolated versus proximal humerus with additional upper limb fractures. At 3-month follow-up, there was significantly better outcomes in Proximal Humeral Internal Locking System (PHILOS) treatment group as compared to PHILOS with bone graft/BMP (p=0.041). PHILOS combined with bone graft/BMP was associated with delayed recovery compared to other management methods. There was non-significant difference in functional outcomes between isolated versus proximal humerus fractures associated with other upper limb fractures, among different fracture categories and between genders.

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.

IntroductionTo date, there is little research assessing the efficacy of a proximal humeral internal locking system (PHILOS) plate plus an allogeneic fibula inserted obliquely in the treatment of 2-part proximal humerus fractures (PHFs) with calcar comminution in patients >60 years old with severe osteoporosis. The aim of this study was to retrospectively evaluate the outcomes of elderly patients with osteoporotic 2-part PHFs combined with medial column (calcar) instability or disruption who experienced a PHILOS plate plus an allogeneic fibula inserted obliquely.Materials and MethodsOne hundred and twelve consecutive elderly patients with severe osteoporotic 2-part PHFs combined with calcar instability or disruption who were treated with a PHILOS plate plus an allogeneic fibula inserted obliquely were retrospectively identified from 3 tertiary medical centres during 2014–2019. The primary outcomes were the Constant scores and American Shoulder and Elbow Surgeons (ASES) scores; secondary outcome was the rate of key orthopaedic complications.ResultsMedian follow-up was 24 (15.3–27.6) months. Significant improvements in the median Constant scores were observed (39 [26–58 points] prior to surgery vs 81 [67–95 points] at final follow-up). The median ASES scores improved from 43 (26–64 points) prior to surgery to 83 (65–96 points) at final follow-up. The percentage of key orthopaedic complications was 25.6% (22/86). Four (4.7%) cases had loss of reduction, 4 (4.7%) experienced aseptic loosening, 1 (.8%) had non-union, 4 (4.7%) suffered a periprosthetic fracture, 3 (3.5%) experienced a revision surgery, 1 (.8%) had a dislocation and 5 (5.8%) suffered an unbearable shoulder pain.ConclusionFor elderly patients with osteoporotic 2-part PHFs combined with calcar instability or disruption, PHILOS plate combined with an allogeneic fibula inserted obliquely might have recognisable advantages in decreasing the loss of fixation and preventing medial calcar collapse.

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

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.

A study of functional and radiological outcome of complex fracutre dislocation of proximal humerus treated with proximal humeral internal locking system (Philos) plate

Fracture dislocations of the proximal humerus are extremely rare and have poor functional and radiological outcome regardless of many available surgical interventions. There has been a wide variation in optimum modality of treatment of proximal humerus fractures ranging from conservative treatment, open reduction and internal fixation to total and reverse shoulder arthroplasty. We have evaluated the outcome of efficacy of proximal humeral internal locking system (PHILOS) plate in complex fracture dislocation of the proximal humerus. A total of 20 patients with fracture dislocation of proximal humerus were included in the study after careful inclusion and exclusion criteria. All fracture dislocations were fixed with proximal humeral internal locking system (PHILOS) plate and patients were followed up at regular intervals. Final evaluation was done based on Neer's scoring system. Open reduction and internal fixation of proximal humeral fracture dislocation with the PHILOS plate was associated with good functional and radiological outcomes provided the correct surgical technique was used.

Preliminary clinical and radiographic outcomes of proximal humeral fractures: comparison of ALPS and PHILOS plating in Asian patients in Taiwan

BackgroundUp to 20% of proximal humeral fractures need to be treated operatively. However, numerus complications were reported by using fixed angled locking plates. The ALPS Proximal Humerus Plating System is a new design implant with novel design features.The aim of this study was to compare the preliminary clinical outcomes and complications of proximal humeral fractures treated with either ALPS or the proximal humeral internal locking system (PHILOS) in Asian patients in Taiwan.MethodsBetween January 2016 and December 2018, 66 patients with displaced proximal humeral fractures were analyzed retrospectively, of whom 31 underwent ALPS implant treatment and 35 underwent PHILOS implant treatment. Intraoperative blood loss and operation time, postoperative Constant-Murley Shoulder Outcome (Constant-Murley) score, and complications variables were recorded for the comparison. All cases were regularly followed up for at least 1 year.ResultsThe mean follow-up period was 400.8 days (range, 367–446 days). Union was achieved in 98.5% of patients (65/66). The ALPS group yielded similar radiologic and clinical outcomes to the PHILOS plating group for treating displaced proximal humeral fractures, including operation time, intraoperative blood loss, the Constant-Murley score, and varus malunion (P > 0.05, respectively). However, the incidence of total postoperative complications in the ALPS group was significantly lower than in the PHILOS group (P < 0.05). There was a trend of a lower complication rate of screws/pegs protrusion, avascular necrosis, subacromial impingement, postoperative infection, and reoperation in the ALPS group, although it was not statistically significant (P > 0.05, respectively).ConclusionThe ALPS group yielded similar radiologic and clinical outcomes to the PHILOS plating group for displaced proximal humeral fractures, but the ALPS group had a significantly lower total rate of complications. Therefore, ALPS may be a better option for treating proximal humeral fractures. Further larger clinical studies are needed to confirm the findings presented here.Trial registrationRetrospective study

Computational optimisation of screw orientations for improved locking plate fixation of proximal humerus fractures

Abstract Background The implant-related failure risks of proximal humerus plates remain high, and therefore, improved solutions are needed. Systematic and efficient computational analyses can assist design optimisation of implant systems and may help reduce complication rates. Methods A previously developed validated computer simulation framework was used to optimise the screw orientations of a standard locking plate. Twenty low-density proximal humerus models with simulated unstable 3-part fractures were fixed using the Proximal Humeral Internal Locking System (PHILOS, DePuy Synthes) with six proximal screws. In a parametric analysis, the screw orientations were varied by relocating their tips within the humeral head and optimised based on two different metrics. In a first approach, average bone mineral density (BMD) around the screw tips was maximised. In a second approach, the average bone strain around the screw tips was evaluated using finite element (FE) analyses in three physiological loading situations and minimized to maximise the predicted fixation stability. Results Optimisation based on BMD did not deliver any improvement. The final FE-based optimised configuration involved the adjustment of each screw and exhibited significantly smaller peri-implant bone strain (−18.49% ​± ​9.56%, p ​ Conclusion Our findings suggest that the design of the investigated proximal humerus plate could be improved by changing the screw orientations. This study demonstrates the potential of FE analyses for implant optimisation. However, the results do not allow direct translation into a novel plate design, mainly owing to the use of a restricted set of bone samples, a single simplified fracture model, and lack of direct biomechanical confirmation of the computational findings. The translational potential of this article A cohort-specific optimised proximal humerus locking plate design was evaluated using a previously validated computer simulation framework. This study showed that screw angle optimisation solely based on BMD is not sufficient and that incorporating the mechanical aspects is required. This approach could be used in the future to inform about the best screw trajectories for variable-angle locking plates or to develop novel implants for improved treatment of proximal humerus fractures. It is therefore expected to help reduce the complication rates of the implant-based treatment of these challenging injuries.

Study on functional outcome of the proximal humeral internal locking system (PHILOS) for displaced proximal humeral fractures in adults

Background: The Incidence of trauma related skeletal injuries have been on the rise in recent years and proximal humerus fractures are one of the most common fractures occurring in the human body. Hence the present study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system (PHILOS) technology.The present study was undertaken to assess the functional and radiological outcome of the proximal humeral internal locking system (PHILOS) for displaced proximal humeral fractures in adults. Method:The present prospective observational study was conducted in adults with proximal humerus fractures admitted to department of orthopedics, GSL Medical College and General hospital Rajahmundry during study period from 1st October 2015 to 31st March 2017. The study was approved by the institute’s ethical committee. Patients were undergo Open reduction internal fixation with philos locking plating for the sustained fracture under general anaesthesia. Post-operative physiotherapy followed according to protocol, to evaluate the functional outcome. Result: The average age of patients was 44 years. Males were 16 and females were 09. Most common mechanism of injury observed was Road traffic accident in 72%. The Constant- Murley score was significantly improved (p=.000) over the successive follow-up period. 01 (04%) patient had excellent Constant-Murley scores, 11 (44%) patients had good scores, as like 11 (44%) had moderate scores and only 2 (08%) patients had a poor functional outcome. Conclusion:In conclusion, the proximal humeral locking plate seems to be an adequate device for the fixation of displaced two-part, three-part and four-part proximal humerus fractures. Due to stable fixation, early functional aftercare is possible and allows the patient to regain good shoulder function and resume normal activities much earlier.