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A low-profile anatomical locking plate for the treatment of humerus split-type greater tuberosity fractures compared
Ning-Jie Zhang1, Yi-Jie Chai2, Yu-Wen Jiang3
1Department of Orthopaedics, Shaoxing TCM Hospital Affiliated to Zhejiang Chinese Medical University (Shaoxing Hospital of Traditional Chinese Medicine), Shaoxing, Zhejiang, China.
Background:
Locking plate fixation is an effective treatment for greater tuberosity (GT) fractures. This study aimed to compare the clinical and radiological outcomes between a low-profile anatomical locking plate (LPALP) and the proximal humeral internal locking system (PHILOS) for displaced split-type GT fractures.
Methods:
Between May 2017 and October 2023, 43 patients, followed for at least 12 months, with split-type GT fractures fixed with a PHILOS or LPALP were included. In this retrospective study, we compared the clinical and radiological outcomes of the 2 groups, assessed using operation time, incision size, blood loss, implant cost, duration of hospital stay, the Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant-Murley (CM) score, visual analogue scale (VAS), 'GT to head height,' secondary displacement of the GT, secondary operation, complications, and patient satisfaction with cosmetic appearance.
Results:
There were 18 patients in the PHILOS group and 25 patients in the LPALP group. Implantation of the PHILOS required a significantly longer operation time (82.4 ± 8.3 vs. 54.5 ± 7.9 min, P < .001), larger incision (9.1 ± 0.6 vs. 5.1 ± 0.4 cm, P < .001), and longer duration of hospital stay (8.2 ± 1.7 vs. 7.0 ± 1.3 days, P = .016) than the LPALP. The PHILOS implant also cost significantly more (15,950 ± 630.8 vs. 13,460 ± 346.4 yuan, P < .001) and involved greater blood loss (102.8 ± 10.9 vs. 52.8 ± 9.8 mL, P < .001) than the LPALP. No significant difference was observed between the 2 groups with respect to the 'GT to head height,' bone union time, secondary displacement of the GT, VAS scores, or incidence of complications. The CM score (91.1 ± 6.8 vs. 83.6 ± 11.3 points, P = .010) and DASH score (7.8 ± 5.0 vs. 13.6 ± 10.0 points, P = .024) were both significantly better in the LPALP group compared with the PHILOS group. In addition, patients in the LPALP group were more satisfied with the cosmetic appearance (92.0% vs. 55.6%, P = .009) and required a lower rate of secondary operation (0.0% vs. 22.2%, P = .024) than the PHILOS group.
Conclusions:
LPALP fixation for displaced split-type GT fractures was associated with a shorter surgical time, smaller incision, reduced blood loss, lower implant costs, better cosmetic and functional outcomes, and a lower reoperation rate compared with PHILOS fixation.
