Long-term follow-up after MIPO Philos plating for proximal humerus fractures
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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.
KeywordsProximal 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.
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.
- 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. https://doi.org/10.1016/j.jse.2009.11.046 CrossRefGoogle Scholar
- 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. https://doi.org/10.1001/jama.2015.1629 CrossRefGoogle Scholar
- 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. https://doi.org/10.1097/BOT.0b013e3181920e5b CrossRefGoogle Scholar
- 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. https://doi.org/10.1007/s00264-015-3069-z CrossRefGoogle Scholar
- 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. https://doi.org/10.1186/1471-2474-15-206 CrossRefGoogle Scholar
- 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. https://doi.org/10.1007/s00402-014-2138-x CrossRefGoogle Scholar
- 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. https://doi.org/10.1016/j.injury.2017.03.027 CrossRefGoogle Scholar
- 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. https://doi.org/10.1007/s11999-016-5113-8 CrossRefGoogle Scholar
- 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. https://doi.org/10.1002/acr.20630 CrossRefGoogle Scholar
- 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
- 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. https://doi.org/10.1302/0301-620x.99b3.bjj-2016-1028 CrossRefGoogle Scholar