Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 2, pp 203–209 | Cite as

Long-term follow-up after MIPO Philos plating for proximal humerus fractures

  • H. FrimaEmail author
  • C. Michelitsch
  • R. B. Beks
  • R. M. Houwert
  • Y. P. Acklin
  • C. Sommer
Trauma Surgery



Minimally invasive plate osteosynthesis (MIPO) has been described as a suitable technique for the treatment of proximal humerus fractures, but long-term functional results have never been reported. The aim of this study was to describe the long-term functional outcome and implant-related irritation after MIPO for proximal humerus fractures.


A long-term prospective cohort analysis was performed on all patients treated for a proximal humerus fracture using MIPO with a Philos plate (Synthes, Switzerland) between December 2007 and October 2010. The primary outcome was the QuickDASH score. Secondary outcome measures were the subjective shoulder value (SSV), implant related irritation and implant removal.


Seventy-nine out of 97 patients (81%) with a mean age of 59 years were available for follow-up. The mean follow-up was 8.3 years (SD 0.8). The mean QuickDASH score was 5.6 (SD 14). The mean SSV was 92 (SD 11). Forty out of 79 patients (50.6%) had implant removal, and of those, 27/40 (67.5%) were due to implant-related irritation. On average, the implant was removed after 1.2 years (SD 0.5). In bivariate analysis, there was an association between the AO classification and the QuickDASH (p = 0.008).


Treatment of proximal humerus fractures using MIPO with Philos through a deltoid split approach showed promising results. A good function can be assumed due to the excellent scores of patient oriented questionnaires. However, about one-third of the patients will have a second operation for implant removal due to implant-related irritation.


Proximal humerus Fracture MIPO Philos Long-term Treatment 



The authors thank Simone Kindle, study nurse, for her efforts in contacting and questioning all patients. They also thank Michelle Reynolds for the excellent copy-editing of this manuscript.


There was no external source of funding for this study.

Compliance with ethical standards

Conflict of interest

Herman Frima, Christian Michelitsch, Reinier B. Beks, Roderick M. Houwert, Yves P. Acklin and Christoph Sommer declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Jones CB, Sietsema DL, Williams DK (2011) Locked plating of proximal humeral fractures: is function affected by age, time, and fracture patterns? Clin Orthop Relat Res 469(12):3307–3316. CrossRefGoogle Scholar
  2. 2.
    Kruithof RN, Formijne Jonkers HA, van der Ven DJC, van Olden GDJ, Timmers TK (2017) Functional and quality of life outcome after non-operatively managed proximal humeral fractures. J Orthop Traumatol. Google Scholar
  3. 3.
    Launonen AP, Lepola V, Saranko A, Flinkkila T, Laitinen M, Mattila VM (2015) Epidemiology of proximal humerus fractures. Arch Osteoporos 10:209. CrossRefGoogle Scholar
  4. 4.
    Olerud P, Ahrengart L, Soderqvist A, Saving J, Tidermark J (2010) Quality of life and functional outcome after a 2-part proximal humeral fracture: a prospective cohort study on 50 patients treated with a locking plate. J Shoulder Elbow Surg 19(6):814–822. CrossRefGoogle Scholar
  5. 5.
    Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92CrossRefGoogle Scholar
  6. 6.
    Rangan A, Handoll H, Brealey S, Jefferson L, Keding A, Martin BC, Goodchild L, Chuang LH, Hewitt C, Torgerson D (2015) Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA 313(10):1037–1047. CrossRefGoogle Scholar
  7. 7.
    Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371. CrossRefGoogle Scholar
  8. 8.
    Handoll HH, Brorson S (2015) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 11:Cd000434. Google Scholar
  9. 9.
    Jawa A, Burnikel D (2016) Treatment of proximal humeral fractures: a critical analysis review. JBJS Rev. Google Scholar
  10. 10.
    Acklin YP, Stoffel K, Sommer C (2013) A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures. Injury 44(4):456–460. CrossRefGoogle Scholar
  11. 11.
    Greiner S, Kaab MJ, Haas NP, Bail HJ (2009) Humeral head necrosis rate at mid-term follow-up after open reduction and angular stable plate fixation for proximal humeral fractures. Injury 40(2):186–191. CrossRefGoogle Scholar
  12. 12.
    Ockert B, Siebenburger G, Kettler M, Braunstein V, Mutschler W (2014) Long-term functional outcomes (median 10 years) after locked plating for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 23(8):1223–1231. CrossRefGoogle Scholar
  13. 13.
    Acklin YP, Sommer C (2012) Plate fixation of proximal humerus fractures using the minimally invasive anterolateral delta split approach. Oper Orthop Traumatol 24(1):61–73. CrossRefGoogle Scholar
  14. 14.
    Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, Kohut G, Ekelund A, Muller M, Audige L, Babst R (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23(3):163–172. CrossRefGoogle Scholar
  15. 15.
    Falez F, Papalia M, Greco A, Teti A, Favetti F, Panegrossi G, Casella F, Necozione S (2016) Minimally invasive plate osteosynthesis in proximal humeral fractures: one-year results of a prospective multicenter study. Int Orthop 40(3):579–585. CrossRefGoogle Scholar
  16. 16.
    Lin T, Xiao B, Ma X, Fu D, Yang S (2014) Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures. BMC Musculoskelet Disord 15:206. CrossRefGoogle Scholar
  17. 17.
    Oh HK, Cho DY, Choo SK, Park JW, Park KC, Lee JI (2015) Lessons learned from treating patients with unstable multifragmentary fractures of the proximal humerus by minimal invasive plate osteosynthesis. Arch Orthop Trauma Surg 135(2):235–242. CrossRefGoogle Scholar
  18. 18.
    Sohn HS, Jeon YS, Lee J, Shin SJ (2017) Clinical comparison between open plating and minimally invasive plate osteosynthesis for displaced proximal humeral fractures: a prospective randomized controlled trial. Injury 48(6):1175–1182. CrossRefGoogle Scholar
  19. 19.
    Sohn HS, Shin SJ (2014) Minimally invasive plate osteosynthesis for proximal humeral fractures: clinical and radiologic outcomes according to fracture type. J Shoulder Elbow Surg 23(9):1334–1340. CrossRefGoogle Scholar
  20. 20.
    Laflamme GY, Rouleau DM, Berry GK, Beaumont PH, Reindl R, Harvey EJ (2008) Percutaneous humeral plating of fractures of the proximal humerus: results of a prospective multicenter clinical trial. J Orthop Trauma 22(3):153–158. CrossRefGoogle Scholar
  21. 21.
    Bahrs C, Kuhle L, Blumenstock G, Stockle U, Rolauffs B, Freude T (2015) Which parameters affect medium- to long-term results after angular stable plate fixation for proximal humeral fractures? J Shoulder Elbow Surg 24(5):727–732. CrossRefGoogle Scholar
  22. 22.
    Beaton DE, Wright JG, Katz JN (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 87(5):1038–1046. Google Scholar
  23. 23.
    Jost B, Pfirrmann CW, Gerber C, Switzerland Z (2000) Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 82(3):304–314CrossRefGoogle Scholar
  24. 24.
    Hulsmans MH, van Heijl M, Houwert RM, Hammacher ER, Meylaerts SA, Verhofstad MH, Dijkgraaf MG, Verleisdonk EJ (2017) High irritation and removal rates after plate or nail fixation in patients with displaced midshaft clavicle fractures. Clin Orthop Relat Res 475(2):532–539. CrossRefGoogle Scholar
  25. 25.
    Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J (2011) Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care Res 63(Suppl 11):S174–S188. CrossRefGoogle Scholar
  26. 26.
    Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the constant score. J Shoulder Elbow Surg 16(6):717–721. CrossRefGoogle Scholar
  27. 27.
    Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L (2007) Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133CrossRefGoogle Scholar
  28. 28.
    Hirschmann MT, Fallegger B, Amsler F, Regazzoni P, Gross T (2011) Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma 25(5):286–293. CrossRefGoogle Scholar
  29. 29.
    Handoll HH, Keding A, Corbacho B, Brealey SD, Hewitt C, Rangan A (2017) Five-year follow-up results of the PROFHER trial comparing operative and non-operative treatment of adults with a displaced fracture of the proximal humerus. Bone Joint J 99-b(3):383–392. CrossRefGoogle Scholar
  30. 30.
    Acklin YP, Michelitsch C, Sommer C (2016) Elective implant removal in symptomatic patients after internal fixation of proximal humerus fractures improves clinical outcome. BMC Musculoskelet Disord 17:119. CrossRefGoogle Scholar
  31. 31.
    Robinson CM, Khan LA, Akhtar MA (2006) Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation. J Bone Joint Surg Br Vol 88(4):502–508. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Trauma SurgeryKantonsspital GraubündenChurSwitzerland
  2. 2.Utrecht TraumacenterUniversitair Medisch Centrum UtrechtUtrechtThe Netherlands
  3. 3.Department of Orthopaedic SurgeryKantonsspital BasellandBruderholzSwitzerland

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