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Proximal humerus fractures are common problems plaguing in geriatric population. Approximately half of all proximal humeral fractures occur due to fall usually at ground level. (Low velocity trauma). In younger individuals fractures occurring because of higher-energy trauma such as a fall from a height, motor vehicle accidents, sports, or assaults. The proximal humerus fracture because of three loading modes: compressive loading of the glenoid onto the humeral head, bending forces at the surgical neck, and tension forces of the rotator cuff at the greater and lesser tuberosities. Most proximal humeral fractures are treated nonoperatively. However, surgical treatment is becoming more popular, with development of modern implant (PHILOS plate). Implant failure is common complication occur due to improper fixation, osteoporotic bone, early mobilization, non-union and varus malalignment. Various modality available for its management i.e., Hemiarthroplasty, reverse shoulder arthroplasty and ORIF + bone graft. IN this case report 60-year male patient with right side proximal humerus fracture treated with PHILOS plating. At 6 week follow up radiograph suggest implant failure. Patient was posted for revision surgery ORIF + platting and fibular strut graft was done.
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Objective To compare biomechanical performance of four-part proximal humeral fractures fixed by novel locking plate or by AO-PHILOS plate. Methods The finite element fixation models of both the novel locking plate and AO-PHILOS plate for four-part proximal humeral fractures were established, respectively. The maximum Von Mises stress and displacement under 4 different functional positions of shoulder abduction in the two fixation models were compared by finite element analysis. Results The maximum displacement in shoulder abduction of 0°,30°,60°,90° were 6.644, 7.079, 5.850, 3.005 mm, respectively, in novel locking plate fixation model, and 6.293, 6.826, 5.774, 3.023 mm, respectively, in AO-PHILOS plate fixation model. Since the maximum displacements in both fracture fixation models were similar, it indicated that there was no significant difference in the stability for fixing proximal humeral fracture. The maximum Von Mises stress in shoulder abduction of 0°,30°,60°,90°were 1 033.0, 904.1, 888.1, 1 062.0 MPa in novel locking plate fixation model, while in AO-PHILOS plate fixation model, it showed 743.1, 692.4,486.4,393.5 MPa, respectively. During the process of shoulder abduction, the total stress in both fracture fixation models gradually decreased, but the new locking plate decreased in a larger range, showing an obvious stress dispersion. Conclusions Both the novel locking plate and AO-PHILOS plate can be used as internal fixation treatment for complex four-part proximal humeral fractures with no significant difference in stress distribution, and both showing a stable fixation effect. For fixing proximal humeral fractures with osteoporosis combined with the great and less tuberosity, the novel locking plate has an advantage over AO-PHILOS plate due to its unique anatomical wings and better fixing effect.
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This is a report of a study on the long term results of PHILOS plating and percutaneous K-wire fixation in a prospective series of proximal humerus fractures in elderly patients. We reviewed a total of 60 patients with proximal humerus fractures in 30 patients (Group 1), who were treated by open reduction and internal fixation with Proximal Humeral Internal Locking System (PHILOS) plate and 30 patients(Group 2) who were treated with percutaneous K-wire fixation. Functional outcome was assessed using Visual Analogue Scale(VAS) and Constant-Murley Score. Mean Constant-Murley score was 84.6 points (range: 61-100) in Group 1 and - 76.4 points(range:56-100) in Group2 at final follow up. Values varied depending upon the fracture type with worst in 4-part fractures. Mean VAS Score was 2.6(range:0-10) in Group 1 and 3.8(range:0-10) in Group 2. We obtained satisfactory results in both the groups, with each procedure having its advantages and shortcomings. We found that PHILOS plate fixation provided stable fixation with minimal implant problems and enabled early range-ofmotionexercises to achieve acceptable functional results. Fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasiveness and soft tissue dissection.
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Fraturas do ÚmeroRESUMO
Estudio descriptivo observacional, retrospectivo tipo serie de casos, realizado entre enero de 2007 y diciembre de 2009 en el Hospital Militar Central. Fueron tratados 21 pacientes con artrosis de la articulación tibio talar y subtalar de etiología diversa, con seguimiento mínimo de 6 meses. Se evaluó; la función pre operatoria y post operatoria por medio de la escala AOFAS, el dolor mediante la escala visual análoga, el tiempo de consolidación con controles radiográficos, el tipo de injerto utilizado y las complicaciones asociadas. Se encontraron como complicaciones 2 pacientes con infección superficial, que requirió manejo con antibiótico endovenoso, y 2 pacientes con retardo en la consolidación que requirieron cirugía de revisión. Los resultados obtenidos demuestran que la artrodesis tibiotalocalcanea con placa philos es un excelente método de fijación (90,4% consolidación) en pacientes con artrosis del tobillo y sub talar y mala calidad ósea...
Descriptive, observational, retrospective, case-series study conducted between January 2007 and December 2009 in the Hospital Militar Central. Twenty one patients with tibiotalar and subtalar joint arthrosis of diverse etiology were treated, with follow-up of at least 6 months. The following facts were assessed: pre-operatory and post-operatory function through the AOFAS scale, pain according to the visual analogue scale, time to consolidation by radiographic controls, type of used graft and associated complications. Complications were found in 2 patients with superficial infection which required management with intravenous antibiotic, and 2 patients showing consolidation delay who required revision surgery. The obtained results demonstrate that tibiotalocalcaneal arthrodesis with Philos plate is an excellent fixation method (90.4% consolidation) in patients with ankle and subtalar arthrosis and poor bone quality...
Estudo descritivo observacional, retrospectivo tipo série de casos, realizado entre janeiro de 2007 e dezembro de 2009 no Hospital Militar Central. Foram tratados 21 pacientes com artrose na articulação tíbio talar e subtalar de etiologia diversa, com acompanhamento mínimo de 6 meses. Foi avaliada a função pré-operatória e pós-operatória por meio da escala AOFAS, a dor mediante a escala visual análoga, o tempo de consolidação com controles radiográficos, o tipo de enxerto utilizado e as complicações associadas. Foram encontradas como complicações 2 pacientes com infecção superficial, que requereram tratamento com antibiótico endovenoso, e 2 pacientes com retardo na consolidação que requereram cirurgia de revisão. Os resultados obtidos demonstram que a artrodese tibiotalocalcânea com placa philos é um excelente método de fixação (90,4% consolidação) em pacientes com artrose do tornozelo e sub-talar e má qualidade óssea...
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Humanos , Osteoartrite/cirurgia , Osteoartrite/patologiaRESUMO
Objective The purpose of our study was to evaluate the treatment of proximal humeral fractures with AO Philos plate. Methods From June 2007 to May 2009, 29 cases of proximal humeral fractures were fixed with AO Philos plate. According to Neer classification, 11 cases were two-part fractures, 16 cases three-part fractures and 2 cases four-part fractures. Results Twenty-nine cases were followed 9-16 months (averaging 11.3 months). The results were evaluated with Neer's evaluation system: 13 patients were graded as excellent,12 as good, 4 as fair. Conclusion AO Philos plate is less invasive comparing with traditional method. It can provide solid fixation, permit early functional rehabilitation and lead to a compromising clinical result.