Article: Shoulder function after helical long PHILOS plate

Background: In order to minimize the risk of damaging the radial nerve while using a long PHILOS plate for proximal humerus fractures, recent studies have proposed twisting the plate in a helical form. This implies a modified surgical approach being yet unclear whether it leads to different middle to long-term shoulder function. This study compares the one-year shoulder functional outcomes of both techniques (helical vs. control).

Methods: In this retrospective comparative study, we analyzed 30 patients that fit the inclusion criteria, being 14 treated with a helical plate and 16 with a conventional straight long PHILOS plate. The primary endpoint was the normalized constant score after a minimum follow up of one year.

Results: Both groups had a good one-year shoulder function, and no significant difference between the normalized constant scores was seen. There was no significant difference in the surgical complications as well.

Conclusion: Opting for a helical long PHILOS plate in order to avoid radial nerve damage provided a safe treatment with similarly good one-year shoulder function compared to straight PHILOS plates.

Level Of Evidence: Level 3, Retrospective Cohort Study.

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References

1.

Claessen F, Peters R, Verbeek D, Helfet D, Ring D . Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures. J Shoulder Elbow Surg. 2015; 24(11):e307-11. DOI: 10.1016/j.jse.2015.07.012. View

2.

Gill D, Torchia M . The spiral compression plate for proximal humeral shaft nonunion: a case report and description of a new technique. J Orthop Trauma. 1999; 13(2):141-4. DOI: 10.1097/00005131-199902000-00013. View

3.

Da Silva T, Rummel F, Knop C, Merkle T . Comparing iatrogenic radial nerve lesions in humeral shaft fractures treated with helical or straight PHILOS plates: a 10-year retrospective cohort study of 62 cases. Arch Orthop Trauma Surg. 2020; 140(12):1931-1937. DOI: 10.1007/s00402-020-03438-y. View

4.

Tan J, Kagda F, Murphy D, Thambiah J, Khong K . Minimally invasive helical plating for shaft of humerus fractures: technique and outcome. Open Orthop J. 2012; 6:184-8. PMC: 3358918. DOI: 10.2174/1874325001206010184. View

5.

Moon J, Kwon H, Biraris S, Shon W . Minimally invasive plate osteosynthesis using a helical plate for metadiaphyseal complex fractures of the proximal humerus. Orthopedics. 2014; 37(3):e237-43. DOI: 10.3928/01477447-20140225-55. View

6.

Katolik L, Romeo A, Cole B, Verma N, Hayden J, Bach B . Normalization of the Constant score. J Shoulder Elbow Surg. 2005; 14(3):279-85. DOI: 10.1016/j.jse.2004.10.009. View

7.

Yang K . Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury. 2004; 36(1):75-80. DOI: 10.1016/j.injury.2004.03.023. View

8.

Gardner M, Griffith M, Lorich D . Helical plating of the proximal humerus. Injury. 2005; 36(10):1197-200. DOI: 10.1016/j.injury.2005.06.038. View

9.

Sproul R, Iyengar J, Devcic Z, Feeley B . A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2010; 42(4):408-13. DOI: 10.1016/j.injury.2010.11.058. View

10.

Brorson S, Rasmussen J, Frich L, Olsen B, Hrobjartsson A . Benefits and harms of locking plate osteosynthesis in intraarticular (OTA Type C) fractures of the proximal humerus: a systematic review. Injury. 2011; 43(7):999-1005. DOI: 10.1016/j.injury.2011.08.025. View

11.

McMillan T, Johnstone A . Primary screw perforation or subsequent screw cut-out following proximal humerus fracture fixation using locking plates: a review of causative factors and proposed solutions. Int Orthop. 2017; 42(8):1935-1942. DOI: 10.1007/s00264-017-3652-6. View

Shoulder Function After Helical Long PHILOS Plate