Session XII - Upper Extremity
Open Reduction and Internal Fixation (ORIF) of Proximal Humerus Fractures with an Angular Stable Form Plate: An International Multicenter Analysis of Outcome and Complications
Purpose: Secondary dislocations were one of the major draw backs in ORIF of proximal humerus fractures. Angular stable implants have the potential of better hold, especially in osteopenic bone. The purpose of this multi-IRB-approved prospective case control study was to examine the long term functional outcome and the complications after ORIF of displaced proximal humerus fractures treated with an angular stable form plate (PHILOS, Synthes).
Methods/Materials: 158 patients with a displaced proximal humerus fracture were treated in 7 institutions according to a standardized peri- and postoperative protocol using a PHILOS plate as a fixation device. Patient data for this report were evaluated at the time of hospitalization (age, gender, type of accident, profession, fracture type according to AO/OTA classification, time to operation, duration of operation, C-arm time) at 3, 6, and 12 months after the intervention. Outcome measures included general complications, operative complications, implant failures, revision surgery, VAS Score for pain, Constant Score (CS), Neer Score, and radiographic evaluation for secondary dislocation, screw penetration, and avascular necrosis. The nonaffected side served as a control.
Results: The study group consisted of 111 females (average 66.5 years, range 18-94) and 47 males (57 years, range 25-88). The study group with a 1-year follow up consisted of 132 patients (83.5%); 6 patients died, 7 refused further controls, and 13 are lost to follow up. There were 61 AO/OTA 11A, 60 AO/OTA 11B, and 11 AO/OTA 11C fractures treated by 52 different surgeons. There were 9 general complications independent of the operative procedure. 12 patients had a secondary loss of reduction, 16 screws perforated the humerus head, 6 screws loosened, and one plate broke. 5 partial and one total avascular necrosis were observed. One revision followed a deep infection and one a hematoma. In total, there were 31 (19.6%) revisions necessary due to complications.
The median functional outcome of the study group using the CS was 73 points (13-100) for the injured side and 84 points (31-100) for the uninjured side. The CS evaluated according to the AO/OTA classification was 76 points for type A fractures (range, 56-100), 74 for type B (15-93), and 72 points for the C-type fractures (13-99). According to Neers Score, 34 patients had an excellent, 37 a satisfactory, and 27 an unsatisfactory result; 31 patients were considered failures.
Conclusion/Significance: Although secondary loss of reduction had a low incidence in this patient population, including 65 patients >65 years of age, there are still a considerable amount of complications when treating proximal humerus fractures with ORIF using the PHILOS plate. Proper operative technique with near anatomic reconstruction and good intraoperative imaging has the potential to prevent the primary observed complication of screw perforation when using this device.