Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Abstract

Purpose: The aim of this study was to evaluate clinical outcomes and complications following minimally invasive plate osteosynthesis (MIPO) with the proximal humeral internal locking system (PHILOS) for treating proximal humeral shaft fracture through the deltopectoral approach.

Methods: Between November 2008 and March 2010, 74 patients with unilateral proximal humeral shaft fractures were treated using the MIPO technique with the PHILOS through the deltopectoral approach. Patients received an average follow-up of 16.9 (range, 12-24) months, and the final follow-up included anteroposterior and lateral imaging and recording of postoperative complications. The Constant-Murley shoulder score was used to evaluate function.

Results: No intraoperative complications occurred. Postoperative complications included subacromial impingement in four patients. There was no deep infection, neurovascular damage, breakage or implant loosening. All fractures united in an average time of 17.4 (15-25) weeks. In terms of function, the Constant-Murley score was 85.8 points on average (range, 67-100). The range of motion of the involved shoulder was satisfactory, and pain-free in 83.8 % of patients.

Conclusions: Using the MIPO technique with the PHILOS through the deltopectoral approach is a valid and safe method of treating proximal humeral shaft fractures.

Fig. 1

Minimally invasive deltopectoral approach for plating proximal humeral shaft fractures. The proximal humeral internal locking system (PHILOS) was inserted proximal to distal. Proximal fragments were stabilised temporarily using a Kirschner wire (a). General view of the approach is shown after closure (b)

Fig. 2

Proximal humeral shaft fractures treated with the proximal humeral internal locking system (PHILOS) through the minimally invasive deltopectoral approach. Anteroposterior view of a proximal humeral shaft fracture categorised as type 12-B1.1 (a). Anteroposterior imaging was used after the fracture was plated with the PHILOS (b). Fracture union was achieved radiographically 15 weeks after the operation (c)