Modified use of a proximal humeral internal locking system (PHILOS) plate in extra-articular distal-third diaphyseal humeral fractures

• Published in: Injury 2019-07, Vol.50 (7), p.1300-1305
• Main Authors: Sohn, Hoon-Sang, Shin, Sang-Jin
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Bone Plates; Bone Screws; Cortical Bone - diagnostic imaging; Cortical Bone - pathology; Cortical Bone - surgery; Distal-third diaphyseal humeral fractures; Female; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fracture Healing - physiology; Humans; Humeral Fractures - diagnostic imaging; Humeral Fractures - pathology; Humeral Fractures - surgery; Male; Middle Aged; Minimally invasive plate osteosynthesis; Open plating; PHILOS; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Young Adult
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.05.030

•The first clinical study on a modified use of the PHILOS plate (upside-down application) as an alternative to different surgical methods in extra-articular distal-third diaphyseal humeral fractures.•The average number of screw fixations in the distal humeral fragment was 5.6 ± 0.7 (range, 4–7).•The mean shortest cortical length was 50.7 ± 14.0 mm (range, 13.2–68.9 mm) which is adequate space for sufficient screw fixations using the PHILOS plate in the distal humeral fragment.•Upside-down application of the PHILOS plate in extra-articular distal humerus fracture can be an alternative method considering the ability to increase plate-screw density with locking screw fixations in a distal humeral fragment. Surgical treatment of extra-articular distal-third diaphyseal humeral fractures is controversial in terms of surgical approach and position of implant. The aim of this study is to evaluate the clinical and radiological outcomes of a modified application of the proximal humeral internal locking system (PHILOS) plate in extra-articular distal-third diaphyseal humeral fractures. A total of 23 patients with extra-articular distal humerus fractures were treated using either open plating or the minimally invasive plate osteosynthesis (MIPO) technique with upside down application of the PHILOS plate. Fracture configuration, number of screws in the distal fragment, and time to union were analysed. Elbow range of motion, Mayo Elbow Performance Score (MEPS), and complications were evaluated at the final follow-up. Fracture union was obtained in all patients at a mean postoperative time of 20.8 ± 2.9 weeks. The mean shortest and longest cortical lengths were 50.7 ± 14.0 mm and 85.2 ± 12.4 mm, respectively. The average number of screws in the distal humeral fragment was 5.6 ± 0.7. No statistically significant correlation was observed between the shortest cortical length and number of screws in the distal fragment (p = 0.224) or between the longest cortical length and the number of screws in the distal humeral fragment (p = 0.956). The average MEPS was 97.6 (range, 75–100). No postoperative complications that required reoperation were occured. A modified anterior application of the PHILOS plate in extra-articular distal-third diaphyseal humeral fracture showed satisfactory outcomes, so it is an alternative when considering the ability to increase plate-screw density with locking screw fixation in a distal humeral fragment. Therapeutic level IV, case series.