Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate
Michael Tobias Hirschmann1, Basil Fallegger, Felix Amsler
1Department of Orthopaedic Surgery and Traumatology, Kantonsspital Bruderholz, Bruderholz, Switzerland. michael.hirschmann@ksbh.ch
Objectives:
The aim of this study was to investigate the subjective and objective longer-term outcomes after fracture fixation with the Proximal Humerus InterLocking OSteosynthesis (PHILOS) plate.
Design:
Minimum 4-year follow-up of a primary prospective cohort study.
Setting:
Single university trauma center.
Patients/Participants:
Sixty-four consecutively collected patients fulfilled the study criteria. Seven patients (11%) were lost to follow-up, resulting in 57 patients (65 ± 14 years).
Intervention:
Open reduction and internal fixation with the PHILOS® plate.
Main Outcome Measurements:
Standardized follow-up including functional outcome instruments (eg, Constant Murley score, Disabilities of the Arm, Shoulder and Hand), rate of complications, and secondary surgeries at 6, 12, and no less than 48 months (uni- and multivariate analysis; P < 0.05).
Results:
At the 4- to 6-year follow-up (median 5 years postinjury), patients on average achieved an 87% range of motion of the injured compared with the uninjured shoulder (eg, 133° ± 40° versus 152° ± 26° abduction). Objective and subjective outcome improved significantly during the overall follow-up, most of all in reoperated and younger patients (65 years and younger) and within the first postinjury year. We observed an overall reoperation rate of 29% and 10 patients (17.5%) demonstrated an insufficient result resulting from pain (greater than 3 visual analog scale) or restricted abduction (less than 90°) at longer-term follow-up. First, the need for revision surgery and, second, increasing age were found to be the most predictive factors for unsatisfactory results.
Conclusions:
Fracture fixation with the PHILOS showed good to excellent longer-term results in three fourths of patients with outcome partially still improving after the first postoperative year.
