Two kinds of locking plate for treatment of proximal humerus fractures in the elderly

doi:10.3969/j.issn.2095-4344.2013.52.012

Abstract

Abstract:

BACKGROUND: Proximal humeral internal locking system (PHILOS) and locking proximal humerus plate (LPHP) are both new types of internal fixation plates, and have satisfactory effects in the treatment of proximal humerus fractures. However, which is better?
OBJECTIVE: To compare the short-term efficacy of PHILOS and LPHP in the treatment of elderly patients with proximal humeral fractures.
METHODS: The follow-up data of 61 elderly patients with proximal humeral fractures were retrospectively analyzed. The patients were divided into PHILOS group (n=34) and LPHP group (n=27). According to the Neer system, there were two parts of fractures in seven cases, three parts of fractures in 11 cases, four parts of fractures in nine cases in LPHP group; there were two parts of fractures in nine cases, three parts of fractures in 14 cases, four parts of fractures in 11 cases in PHILOS group. The operation time, blood loss, and drainage volume were recorded. The time of fracture healing, functional recovery, and complications were observed. Statistical analysis was performed.
RESULTS AND CONCLUSION: All 61 patients were followed up for 12-36 months (mean 20.6 months). There was no statistical difference in operation time, blood loss, drainage volume, time of fracture healing, functional recovery and complications between the two groups (P > 0.05). Both LPHP and PHILOS groups could obtain good effects in treatment of senile proximal humeral fractures. The excellent and good rate was respectively 81.5% and 82.4% in two groups. They have advantages of reliable fixation, few complications, and high satisfaction rate. Currently these locking plates have a high clinical value and can be considered as useful implants for ORIF of displaced and unstable proximal humeral fractures.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: humerus, humeral fractures, internal fixators, aged

CLC Number:

R318

Chen Li, Zhao Di-qing, Yang Guang-zhong, Chen Gang. Two kinds of locking plate for treatment of proximal humerus fractures in the elderly[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(52): 9011-9016.

Figures/Tables 6

References

[1] Kannus P, Palvanen M, Niemi S, et al. Rate of proxinlal humeral fractures in older Finnish women between 1970 and 2007. Bone.2009;44(4):656-659.

[2] 张德光,刘福金,刘爱华.肱骨近端骨折锁定加压接骨板内固定治疗肱骨近端骨折[J].中华创伤杂志,2006,22(11):836-838.

[3] Bjorkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75(6):741-745.

[4] Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970; 52(6):1077-1089.

[5] Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res.1987; (214):160-164 .

[6] Norouzi M, Naderi MN, Komasi MH, et al. Clinical results of using the proximal humeral internal locking system plate for internal fixation of displacedproximal humeral fractures. Am J Orthop (Belle Mead NJ).2012;41(5):E64-68.

[7] 刘印文.手法闭合复位经皮微创固定治疗肱骨近端骨折[J].中国骨伤,2012,24(11):949-951.

[8] Weinstein DM, Bratton DR, Ciccone WJ 2nd, et al. Locking plates improve torsional resistance in the stabilization of three-part proximal humeral fractures. J Shoulder Elbow Surg. 2006;15(2):239-243.

[9] El-Sayed MM. Surgical management of complex humerus head fractures. Orthop Rev (Pavia). 2010;2(2):e14.

[10] Wild JR, DeMers A, French R, et al. Functional outcomes for surgically treated 3- and 4-part proximal humerus fractures. Orthopedics. 2011;34(10):e629-633.

[11] 熊进,施鸿飞,王守丰,等.应用内固定锁定系统治疗老年肱骨近端骨折[J].中国矫形外科杂志,2009,17(20):1585-1587.

[12] Gavaskar AS, Muthukumar S, Chowdary N. Biological osteosynthesis of complex proximal humerus fractures: surgical technique and results from a prospective single center trial. Arch Orthop Trauma Surg. 2010;130(5):667-672.

[13] Thanasas C, Kontakis G, Angoules A, et a1. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg. 2009;18(6):837-844.

[14] Ruchholtz S, Hauk C, Lewan U, et al. Minimally invasive polyaxial locking plate fixation of proximal humeral fractures: a prospective study. J Trauma. 2011;71(6):1737-1744.

[15] 胡稷杰,金丹,魏宽海,等.肱骨近端锁定钢板或肱骨近端内锁定系统与其他内固定治疗肱骨近端骨折的Meta分析[J].中华创伤骨科杂志,2012,14(12):1047-1054

[16] 程兴东,孙强,曾逸文.高龄肱骨近端骨折患者的外科治疗[J].中国骨质疏松杂志,2012,18(1):33-35.

[17] Hettrich CM, Neviaser A, Beamer BS, et al. Locked plating of the proximal humerus using an endosteal implant. J Orthop Trauma. 2012;26(4):212-215.

[18] 何小健,庄健,周凯华,等. 锁定接骨板治疗肱骨近端三、四部分骨折[J].中国组织工程研究,2013,17(4):688-695.

[19] 黄磊,李广旭,李波,等.PHILOS锁定加压接骨板与肱骨近端锁定加压接骨板治疗肱骨近端骨折[J].中国组织工程研究与临床康复, 2010,14(52):9861-9864 .

[20] Faraj D, Kooistra BW, Vd Stappen WAH, et al. Results of 131 consecutive operated patients with a displaced proximal humerus fracture: an analysis with more than two years follow-up. Eur J Orthop Surg Traumatol.2011;21(1):7-12.

[21] Konrad G, Hirschmüller A, Audige L, et al. Comparison of two different locking plates for two-, three- and four-part proximal humeral fractures--results of an international multicentre study. Int Orthop. 2012;36(5):1051-1058.

[22] 方铭,孙贤杰,曹铨,等.锁定接骨板治疗老年肱骨近端骨折的近期疗效[J].临床骨科杂志,2012,15(4):400-401.

[23] 张华,倪卫东,高仕长,等.锁定加压接骨板治疗肱骨近端骨折[J].中华创伤杂志,2008,24(7):527-530.

[24] 付中国,邓磊,白露,等.肱骨近端骨折锁定接骨板治疗术后并发症分析[J].北京大学学报(医学版),2011,43(5):666-670.

[25] 曾浪清,陈云丰,刘燕洁,等.内侧柱支撑重建在锁定钢板治疗成人肱骨近端骨折中的临床意义[J].中华创伤骨科杂志,2012, 14(7): 561-565.

[26] Baumgartner D, Nolan BM, Mathys R, et al. Review of fixation techniques for the four-part fractured proximal humerus in hemiarthroplasty. J Orthop Surg Res. 2011;6:36.

[27] Lescheid J, Zdero R, Shah S, et al. The biomechanics of locked plating for repairing proximal humems fractures with or without medial cortical support.J Trauma.2010;69(5):1235- 1242.

[28] Röderer G, Erhardt J, Kuster M, et al. Second generation locked plating of proximal humerus fractures--a prospective multicentre observational study. Int Orthop. 2011;35(3):425- 432.

[29] 黄强,王满宜,荣国威.复杂肱骨近端骨折的手术治疗[J].中华骨科杂志,2005;25(3):159-164.

[30] Spross C, Platz A, Rufibach K, et al. The PHILOS plate for proximal humeral fractures-Risk factors for complications at one year. J Trauma. 2012;72(3):783-792.

[31] Wijgman AJ, Roolker W, Patt TW, et a1. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am .2002;84-A(11): 1919-1925.

[32] Jost B, Spross C, Grehn H, et al. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg. 2013; 22(4):542-549.