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. 2015:2015:971216.
doi: 10.1155/2015/971216. Epub 2015 Nov 26.

Minimal Invasive Percutaneous Osteosynthesis for Elderly Valgus Impacted Proximal Humeral Fractures with the PHILOS

Hang Chen  1 , Xiaochuan Hu  1 , Haochen Tang  1 , Guoyong Yang  1 , Ming Xiang  1
Affiliations

Minimal Invasive Percutaneous Osteosynthesis for Elderly Valgus Impacted Proximal Humeral Fractures with the PHILOS

Hang Chen et al. Biomed Res Int. 2015.

Abstract

There is a growing concern about elderly valgus impacted proximal humeral fractures. The aim of this study was to evaluate the treatment and clinical outcomes following minimal invasive percutaneous plate osteosynthesis (MIPPO) with the proximal humeral internal locking system (PHILOS) for the treatment of elderly valgus impacted proximal humeral fracture. Between May 2008 and May 2012, 27 patients (average age 67.3, range 61-74) with valgus impacted proximal humeral fractures were enrolled in the study. The patients were treated with MIPPO using PHILOS-plate through the anterolateral delta-splitting approach. Rehabilitation exercises were done gradually. The NEER score and Constant-Murley score were used to evaluate shoulder function. All the patients were followed up by routine radiological imaging and clinical examination. There were 15 cases of II-part greater tuberosity fractures, 10 cases of III-part greater tuberosity fractures, and 2 cases of IV-part fractures according to the NEER classification. The surgery was successful in all patients with an average follow-up of 20.8 (range: 11-34) months. The fractures united in an average of 7.2 (6-14) weeks without implant loosening. According to NEER score, there were 17 excellent, 7 satisfactory, 2 unsatisfactory, and 1 poor. The mean Constant-Murley score was 89.4 ± 4.35. No complication including axillary nerve damage, postoperative nerve or vessel damage, infections, DVT, or death was observed. In conclusion, the MIPPO technique with the PHILOS through the anterolateral delta-splitting approach seems to be a safe and easy treatment for elderly valgus impacted proximal humeral fractures. A case-control study and longer follow-up time are needed.

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Figures

Figure 1
Figure 1
MIPPO with anterolateral delta-split approach in a patient with II-part greater tuberosity fracture: the skin incision at the anterolateral tip of the acromion.
Figure 2
Figure 2
(a) Anteroposterior view and (b) lateral view of plate fixation and reduction in a patient with II-part greater tuberosity fracture.
Figure 3
Figure 3
Preoperative (a) and postoperative (b) radiograph (lateral view) of proximal humeral fractures in a patient with II-part greater tuberosity fracture.
Figure 4
Figure 4
(a) The incision healed during the follow-up in a patient with II-part greater tuberosity fracture. ((b) and (c)) After removal of the implant, the patient has good function.
See this image and copyright information in PMC

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