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Review
. 2022 Feb 19;12(2):311.
doi: 10.3390/life12020311.

PHILOS Synthesis for Proximal Humerus Fractures Has High Complications and Reintervention Rates: A Systematic Review and Meta-Analysis

Lorenzo Massimo Oldrini  1 , Pietro Feltri  1 , Jacopo Albanese  1 , Francesco Marbach  1 , Giuseppe Filardo  1   2 , Christian Candrian  1   2
Affiliations
Review

PHILOS Synthesis for Proximal Humerus Fractures Has High Complications and Reintervention Rates: A Systematic Review and Meta-Analysis

Lorenzo Massimo Oldrini et al. Life (Basel). .

Abstract

Purpose: The aim of this study was to quantify the rate of complications and reinterventions in patients treated with PHILOS plate for proximal humerus fractures (PHFs) synthesis.

Methods: A comprehensive literature search was performed on the PubMed, Web of Science, Embase, and Cochrane databases up to 7 October 2021. Studies describing medium and long-term complications in PHF synthesis using the PHILOS plate were included. A systematic review and meta-analysis were performed on complications and causes of reinterventions. Assessment of risk of bias and quality of evidence was performed with the Downs and Black's "Checklist for Measuring Quality".

Results: Seventy-six studies including 4200 patients met the inclusion criteria. The complication rate was 23.8%, and the main cause was screw cut-out (4.1%), followed by avascular necrosis (AVN) (3.1%) and subacromial impingement (1.5%). In patients over 55 years, the complication rate was 29.5%. In the deltopectoral (DP) approach the complication rate was 23.8%, and in the delto-split (DS) it was 17.5%, but no difference between the two approaches was seen when considering the type of fracture. The overall reintervention rate was 10.5% in the overall population and 19.0% in older patients.

Conclusions: Proximal humerus synthesis with a PHILOS plate has high complications and reintervention rates. The most frequent complication was screw cut-out, followed by humeral head AVN and subacromial impingement. These results need to be further investigated to better understand both the type of patient and fracture that is more at risk of complications and reintervention and to compare pros and cons of the PHILOS plate with respect to the other solutions to manage PHFs.

Keywords: PHF; PHILOS; locking plate; osteosynthesis; proximal humeral fracture.

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Conflict of interest statement

All authors declare no support from any organization for the submitted work; Christian Candrian has received institutional support outside the present work from Medacta International SA, Johnson & Johnson, Lima Corporate, Zimmer Biomet, and Oped AG.

Figures

Figure 1
Figure 1
P.R.I.S.M.A. (Preferred Reporting Items for Systematic Meta-Analyses) flowchart of the study selection process. Assessment of risk of bias and quality of evidence.
Figure 2
Figure 2
Complications and reinterventions causes; data reported as percentages of the total complications and reinterventions.
Figure 3
Figure 3
Downs and Black’s tool for assessing the risk of bias. For the explanation of each column question, see Appendix A.
Figure 3
Figure 3
Downs and Black’s tool for assessing the risk of bias. For the explanation of each column question, see Appendix A.
None
None
See this image and copyright information in PMC

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