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The PHILOS plate for proximal humeral fractures--risk factors for complications at one year


Spross, Christian; Platz, Andreas; Rufibach, Kaspar; Lattmann, Thomas; Forberger, Jens; Dietrich, Michael (2012). The PHILOS plate for proximal humeral fractures--risk factors for complications at one year. Journal of Trauma and Acute Care Surgery, 72(3):783-792.

Abstract

BACKGROUND: Since 2003, we have used the Proximal Humerus Interlocking System plate for treatment of proximal humeral fractures. Although many patients have good and excellent results, the reported rate of complications varies. We have focused on the complication rate and risk factors for complications 1 year after surgery.
METHODS: From 2003 until 2008, a total of 294 (223 women; 71 men; median age, 72.9) patients were included. General data were collected at the time of injury (Charlson Index, smoking, and steroid therapy). Fractures were classified (AO/OTA) retrospectively. The follow-up of 1 year included radiographs and Constant-Murley score for functionality. Complications and revision surgeries were analyzed specifically.
RESULTS: We found 83 (28.2%) patients with a total of 105 complications, requiring a total of 72 (24.5%) revision surgeries. The most frequent complication was screw cutout (33 of 294, 11.2%), because of secondary fracture displacement or avascular necrosis (AVN). AVN (20 of 294, 6.8%) was the main reason for secondary arthroplasty. Smoking more than 20 pack years had a significant impact on the complication rate. Fractures classified 11-A3 showed more implant failures. Fracture dislocations predisposed to secondary screw cutout and AVN. Patients without complications (211, 71.8%) achieved a median Constant-Murley score of 89 (40-100) points.
CONCLUSION: This study points out several predisposing factors for negative outcome after open reduction and internal fixation with the Proximal Humerus Interlocking System plate (fracture type: 11-A3, fracture dislocations, and smoking). Accounting for these, patient's risk for complications can be evaluated more individually and taken into consideration for the concept of treatment. Altering the surgical technique was associated with a significant reduction in the incidence of secondary screw cutout.

Abstract

BACKGROUND: Since 2003, we have used the Proximal Humerus Interlocking System plate for treatment of proximal humeral fractures. Although many patients have good and excellent results, the reported rate of complications varies. We have focused on the complication rate and risk factors for complications 1 year after surgery.
METHODS: From 2003 until 2008, a total of 294 (223 women; 71 men; median age, 72.9) patients were included. General data were collected at the time of injury (Charlson Index, smoking, and steroid therapy). Fractures were classified (AO/OTA) retrospectively. The follow-up of 1 year included radiographs and Constant-Murley score for functionality. Complications and revision surgeries were analyzed specifically.
RESULTS: We found 83 (28.2%) patients with a total of 105 complications, requiring a total of 72 (24.5%) revision surgeries. The most frequent complication was screw cutout (33 of 294, 11.2%), because of secondary fracture displacement or avascular necrosis (AVN). AVN (20 of 294, 6.8%) was the main reason for secondary arthroplasty. Smoking more than 20 pack years had a significant impact on the complication rate. Fractures classified 11-A3 showed more implant failures. Fracture dislocations predisposed to secondary screw cutout and AVN. Patients without complications (211, 71.8%) achieved a median Constant-Murley score of 89 (40-100) points.
CONCLUSION: This study points out several predisposing factors for negative outcome after open reduction and internal fixation with the Proximal Humerus Interlocking System plate (fracture type: 11-A3, fracture dislocations, and smoking). Accounting for these, patient's risk for complications can be evaluated more individually and taken into consideration for the concept of treatment. Altering the surgical technique was associated with a significant reduction in the incidence of secondary screw cutout.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2012
Deposited On:22 Oct 2012 08:32
Last Modified:05 Apr 2016 16:01
Publisher:Lippincott Williams & Wilkins
ISSN:2163-0755
Publisher DOI:https://doi.org/10.1097/TA.0b013e31822c1b5b
PubMed ID:22491570

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