Early experience with the PlantTan Fixator Plate for 2 and 3 part fractures of the proximal humerus

Proximal humerus fracture management and outcomes are distinctly different for individuals 60 years of age or younger: a systematic review

Background

Proximal humerus fractures (PHFs) occur most commonly in an elderly and osteoporotic population, but a considerable proportion of these injuries occur in relatively younger individuals. Differences in treatment principles and outcomes in this younger population remain poorly understood. The purpose of this review was to characterize the treatment algorithms and outcomes for patients less than or equal to 60 years of age with PHFs.

Methods

A comprehensive search of the Medline, Pubmed, Embase, and Cochrane databases for articles published between January 2005 and December 2020 was performed in January 2021. Levels of evidence I-IV analyzing outcomes (patient reported outcomes and/or complications) following PHFs in adult patients less than or equal to 60 years of age were included. The search was carried out in accordance with the preferred reported items for systematic reviews and meta-analyses guidelines. The risk of bias 2 tool and methodological index for nonrandomized studies score were utilized to evaluate included studies.

Results

Fourteen studies met the inclusion criteria (open reduction internal fixation: 5, intramedullary nail: 4, hemiarthroplasty: 2, nonoperative: 1, and reverse total shoulder arthroplasty (RTSA): 1). Seven studies reported differences in outcomes between younger and older patient populations, with three studies noting separate management algorithms for those 60 years of age or younger. There were no studies comparing different treatments modalities in those less than 60 years of age, and the lone study on RTSA did not include patient-reported outcomes.

Conclusion

Treatment algorithms and outcomes following PHFs in patients less than or equal to 60 years of age are distinctly different from that of a more elderly population. However, evidence-based treatment recommendations for this younger population are limited by the lack of studies comparing treatment modalities and the absence of patient-reported outcomes for individuals undergoing RTSA.

A vast majority of preliminary reports published in the shoulder literature are not followed by long-time follow-up studies - a literature review

INTRODUCTION

The aim of paper is to check how many preliminary reports (PR) reach a long-term publication (LT), and analyse differences in outcomes and complications between them.

METHODS

A literature search was performed to identify shoulder preliminary or early reports. Fifty one papers fulfilled criteria and were categorized for paper topic. Bibliographic searches were undertaken to find LT on the topic from the same author or research group. Outcomes and complications reported in PR were recorded and compared to those reported in LT.

RESULTS

Ten out of 51 PR (19.61 %) were followed by a LT with minimum follow-up of five years, by the same authors. Complication and reintervention rate were higher in the LT compared to PR (p < 0.05). Results published on PR were better than results published on LT even though these differences did not reach significance (p = 0.08).

DISCUSSION

PR may represent the fastest way to spread new findings. However, concerns regarding short-term follow-up, small sample size bias and decrease in outcomes over time can discourage promising preliminary results.

CONCLUSIONS

The vast majority of preliminary reports never reached a LT follow-up paper. Preliminary reports underestimate complications and tend to overestimate outcomes.

New trends in fixation of proximal humeral fractures: a review

Surgical treatment of proximal humeral fractures continues to be a challenge especially in osteoporotic patients. Locking plates and intramedullary nails have been used with satisfactory results but the previous reported complications have not been substantially reduced. Most of the existing studies involve a small number of patients followed up for a rather short period of time. Since proximal humeral fractures constitute a heterogenous group of complex fractures in an even more heterogenous population, no single fixation method is a panacea. Choice of implant and method of fixation should be selected according to individual patient and fracture pattern characteristics based on clearly defined indications and contraindications. Based on the findings of the existing clinical studies the authors propose a treatment algorithm.

The biomechanics of locked plating for repairing proximal humerus fractures with or without medial cortical support

BACKGROUND

Comminuted proximal humerus fracture fixation is controversial. Locked plate complications have been addressed by anatomic reduction or medial cortical support. The relative mechanical contributions of varus malalignment and lack of medial cortical support are presently assessed.

METHODS

Forty synthetic humeri divided into three subgroups were osteotomized and fixed at 0 degrees, 10 degrees, and 20 degrees of varus malreduction with a locking proximal humerus plate (AxSOS, Global model; Stryker, Mahwah, NJ) to simulate mechanical medial support with cortical contact retained. Axial, torsional, and shear stiffness were measured. Half of the specimens in each of the three subgroups underwent a second osteotomy to create a segmental defect simulating loss of medial support with cortex removed. Axial, torsional, and shear stiffness tests were repeated, followed by shear load to failure in 20 degrees of abduction.

RESULTS

For isolated malreduction with cortical contact, the construct at 0 degrees showed statistically equivalent or higher axial, torsional, and shear stiffness than other subgroups examined. Subsequent removal of cortical support in half the specimens showed a drastic effect on axial, torsional, and shear stiffness at all varus angulations. Constructs with cortical contact at 0 degrees and 10 degrees yielded mean shear failure forces of 12965.4 N and 9341.1 N, respectively, being statistically higher (p < 0.05) compared with most other subgroups tested. Specimens failed primarily by plate bending as the humeral head was pushed down medially and distally.

CONCLUSIONS

Anatomic reduction with the medial cortical contact was the stiffest construct after a simulated two-part fracture. This study affirms the concept of medial cortical support by fixing proximal humeral fractures in varus, if absolutely necessary. This may be preferable to fixing the fracture in anatomic alignment when there is a medial fracture gap.

EVALUATION OF SURGICAL TREATMENT OF FRACTURES IN TWO OR THREE PARTS OF THE PROXIMAL HUMERUS WITH THE "PARACHUTE TECHNIQUE"

Objective: To evaluate the efficacy and safety of the surgical technique called the “parachute technique, as applied to adult patients who suffered displaced and unstable two or three-part fractures of the proximal humerus, through the clinical outcomes. Methods: Between January 1995 and June 2006, 59 adult patients with displaced and unstable two or three-part fractures underwent operations performed by the Shoulder and Elbow Group of the Orthopedics and Traumatology Service of Hospital do Servidor Público Estadual de São Paulo using the “parachute technique. This method consists of an intramedullary tension band and extramedullary fixation in a figure-of-eight to join the fragments of the fracture, using a 6.5-millimeter spongy screw with partial threading, a washer and two non-absorbable wires, thereby producing stable synthesis with minimal aggression to the surrounding soft tissue and not requiring any subsequent removal of material. The final shape of this synthesis is reminiscent of the shape of an open parachute. The patients had a minimum postoperative follow-up of six months. For the diagnosis, trauma series radiographic views of the shoulder were produced. The fractures were classified in accordance with the system proposed by Neer. We used the scale of the University of California, Los Angeles (UCLA), to evaluate the results. Results: The “parachute technique” produced good results in 47% and excellent results in 26% of the cases, according to the UCLA scores. Conclusion: The “parachute technique” is a safe and effective treatment for displaced and unstable two or three-part fractures of the proximal humerus.

A prospective study of a new locking plate for proximal humeral fracture

Displaced and unstable extra-articular fractures of the proximal humerus are treated by operative reduction and fixation using various techniques such as fixed plates and intramedullary implants. This prospective study evaluates the clinical efficacy of a novel implant that is attached to the humeral head with fixed-angle locking screws. Between October 2002 and November 2005, 99 people (mean age 62.8 years) with proximal humeral fractures received treatment involving this plate in our department. The mean follow-up time was 17.8 months. Outcome was assessed with radiography, the Constant-Murley (C-M) shoulder evaluation and the Disabilities of the Arm, Shoulder and Hand (DASH) score. The mean C-M score was 64.95% and the mean DASH score was 30.1 points. Outcome was judged excellent in 51%, good in 19%, moderate in 19% and poor in 11% of cases.

Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures

INTRODUCTION

The aim of this study was to describe early results of a new internal locking system, PHILOS, used for the treatment of proximal humeral fractures.

MATERIALS AND METHODS

A chart and radiographic review of 25 cases that had proximal humeral internal locking system (PHILOS) plate for the treatment of proximal humeral fractures was performed.

RESULTS

Of the 25 cases, 20 went to union with a mean neck/shaft angle of 127.2 degrees . Five cases required or were considered for revision surgery for non-union or implant failure. Of the 25 implants, 4 had screw protrusion into the gleno-humeral joint, 4 had screw loosening and backing out, and 1 plate broke without further trauma.

CONCLUSIONS

Our results suggest that PHILOS is an effective system for providing fracture stabilisation to bony union but awareness of potential hardware complications is essential.