Use of a proximal humeral internal locking system enhanced by injectable graft for minimally invasive treatment of osteoporotic proximal humeral fractures in elderly patients

Abstract

Objective: To investigate the effect of treatment of osteoporotic proximal humeral fractures in elderly patients with a proximal humeral internal locking system (PHILOS) and minimally invasive injectable graft (MIIG).

Methods: Patients who conformed to the inclusion criteria were randomly divided into two groups: group A (21 cases) were treated with PHILOS alone and group B (29 cases) were treated with PHILOS augmentation plus minimally invasive injectable graft (MIIG) X3 Hivisc. Postoperative follow-up was performed regularly to check for complications, reduction loss and fracture healing by imaging. Shoulder joint function was scored and clinical results evaluated according to the Neer scoring system.

Results: All patients were followed-up and achieved fracture healing. The complication rate in group A (six cases) was greater than in group B (one case), the differences being statistically significant. The reduction loss in group A (2.9 ± 0.4 mm) was greater than in group B (1.5 ± 0.3 mm), this difference also being statistically significant. According to the Neer system, the excellent and good rate was 76.2% in group A and 82.8% in group B.

Conclusion: PHILOS using MIPPO and augmented with MIIG X3 Hivisc produces satisfactory clinical results in aged patients with osteoporotic proximal humeral fractures and the method has advantages such as relatively minor trauma, stable fixation, fewer complications, and better joint function.

Figure 1

A 67 year‐old man with left proximal humeral fractures caused by a fall. (a) Preoperative X‐ray film and (b) CT scan showed left proximal humeral fractures. He was treated with PHILOS using MIPPO augmented by MIIG X3 Hivisc. (c) At 2 weeks postoperatively, an X‐ray film showed good reduction; and (d) at 12 months postoperatively, fixation was removed, and the X‐ray film showed fracture healing.