scholarly journals Surgical management of complex humerus head fractures

2010 ◽  
Vol 2 (1) ◽  
pp. 14 ◽  
Author(s):  
Mohamed M.H. El-Sayed
Keyword(s):  
Proximal Humerus ◽  
Age Groups ◽  
Osteoporotic Fractures ◽  
Scoring Systems ◽  
High Energy ◽  
High Rate ◽  
Trauma Patients ◽  
Fracture Dislocations ◽  
Philos Plate

The locked plate systems provided adequate fixation of osteoporotic fractures of the proximal humerus in the elderly. But is the PHILOS plate adequate for stabilization of high-energy fractures, and fracture-dislocations of the proximal humerus in relatively younger age populations? In this retrospective study, performed at a referral, academic supervised, level III-trauma center, all high-energy trauma patients under the age of 55 years, with closed, 3 part, 4 part fractures, and/or fracture dislocations, were included in this study. Patients with open fractures, osteoporotic low-energy fractures, as well as patients older than 55 years were excluded. Fifty-nine patients entered and completed the study. They were all managed by open reduction and internal fixation using the PHILOS plate system. Patients’ age ranged between 31-52 years, with a mean of 42 years. A minimal follow-up period of two years was a mandatory inclusion criterion in this study. All the patients who did not complete the follow-up period were excluded from the study. The results were evaluated using the Constant, Neer and DASH scoring systems, which revealed favorable results in 41 patients (69.5%). The results were comparable to the recent articles published in the literature in relatively older age groups. It was concluded that, despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of polytrauma patients.

scholarly journals Evaluation of results of three and four-part fracture dislocations of proximal humerus in young adults using philos (proximal humerus internal locking system)

2018 ◽  
Vol 6 (2) ◽  
pp. 585
Author(s):  
Amit Thakur ◽  
Khalid Muzzafar ◽  
Sumeet Singh Charak ◽  
Bias Dev ◽  
Abdul Ghani
Keyword(s):  
Proximal Humerus ◽  
Young Patients ◽  
Soft Tissue Injuries ◽  
Functional Results ◽  
High Energy ◽  
High Rate ◽  
Fracture Dislocation ◽  
Rotator Cuff Insufficiency ◽  
Fracture Dislocations ◽  
Adequate Management

Background: The fractures of proximal humerus constitute about 5% of fractures in adults third in number to fracture colles and hip usually in elderly patients due to a low energy trauma. In young patients the fractures are mostly due to high energy trauma and as such are associate with other soft tissue injuries. A sub group of young patients have a three or four fracture dislocation of shoulder joint. The aim of this study was to find the results of fixation by PHILOS in these young patients.Methods: This study was done in a teritiary referral centre over a period of about 1 year. All patients were operated within three weeks. Open fractures, patients with age more than 50 years were excluded from the study. All patients underwent open reduction and fixation using commercially available PHILOS. A minimum of 6 months follows up was essential for inclusion into the study. Final functional results were evaluated by Constant Murley scoring.Results: 14 patients were included in the study. The average age of patients was 38.42years. All fractures united. We had 71.4% excellent or good results. The complications noted were shoulder stiffness in 3, inadequate post op reduction, rotator cuff insufficiency, head necrosis, secondary osteo arthritis 1 each.Conclusions: Despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of these patients.

scholarly journals Analysis of surgical fixation of displaced proximal humerus fractures using PHILOS plate

2016 ◽  
Vol 2 (4) ◽  
pp. 245
Author(s):  
Lalith Mohan Chodavarapu ◽  
Sreekanth Kashayi Chowdojirao ◽  
Avinash Gonu ◽  
Chandrasekhar Patnala ◽  
Vijay Krishna Chilakamarri
Keyword(s):  
Proximal Humerus ◽  
Dash Score ◽  
Proximal Humerus Fractures ◽  
Independent Observer ◽  
Constant Murley Score ◽  
Fracture Dislocations ◽  
Philos Plate ◽  
Humerus Fractures ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The treatment of displaced proximal humeral injuries still throws challenges in identifying variables to prognosticate the outcome and optimizing a good clinical result. This study attempts to analyze the functional outcome of surgery of such fractures with proximal humeral interlocking system (PHILOS) plate and evaluate variables which help in predicting the prognosis.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective and prospective study of 30 patients with displaced proximal humerus fractures - 2 part, 3 part, 4 part and fracture dislocations according to Neer classification, surgically treated using PHILOS plate during 2011 and 2014. Evaluation of patients was done on follow-up by an independent observer for union by radiographs and functional assessment by Constant-Murley score and DASH (disabilities of the arm, shoulder and hand) score.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age of the patients was 40.4 years (range 18-65). 83.3% of the patients were male. The mean follow-up was 18.9 months (4-36 months). The mean Constant-Murley score and the DASH score were 76 and 16 respectively at the last follow-up. Our analysis showed that the patient’s age, delay in surgery, and Neer’s classification influenced the prognosis of the fracture. Medial metaphyseal extension in the fracture or an intact medial neck showed a better outcome. Complications were seen in 5 patients. Avascular necrosis was seen in 3 patients.</p><p><strong>Conclusions:</strong> Osteosynthesis of displaced proximal humeral fractures with PHILOS plate provides a good outcome, with low complication rate. Patient’s age and the type of fracture based on Neer’s classification prognosticate the outcome. </p>

A STUDY ON FUNCTIONAL OUTCOME OF PROXIMAL HUMERUS FRACTURES TREATED WITH PHILOS PLATING

2021 ◽  
pp. 5-7
Author(s):  
M.V. Sudhakar ◽  
R.Ashok kumar ◽  
A. Deepak ◽  
B.S.S.S. Venkateswarlu
Keyword(s):  
Functional Outcome ◽  
Proximal Humerus ◽  
High Energy ◽  
Proximal Humerus Fractures ◽  
Non Union ◽  
Constant Murley Score ◽  
Philos Plate ◽  
Humerus Fractures ◽  
The Mean

Background: Proximal humerus fractures are common and debilitating injuries. These fractures have a dual age distribution occurring either in young people following high energy trauma Usually high energy trauma associated with dislocation or in those older than 60 years with low-velocity injuries like simple fall, especially in elderly patients is due to osteoporosis and deforming forces of muscle attached. Wide range of treatment modalities ranging from conservative management to reverse shoulder arthroplasty. The non-operative method gives good results in stable and minimally displaced fractures. Displaced humeral neck fractures used to be managed conservatively in the past, but these were complicated by loss of reduction, malunion, non-union, stiffness and ultimately poor functional outcome. We took up this study to assess the efcacy and functional outcome of P.H.I.L.O.S. plating in proximal humerus. Our objectives are to study the fracture pattern with the Neer's criteria, to reconstruct the proximal humerus fracture anatomically with Philos plate, allow early shoulder mobilization and assessing the functional outcome using Constant Murley score. It is an Materials and methods: observational study of 30 patients (18 females and 12 males) with proximal humerus fractures that attended to the Department of Orthopaedics, Government General Hospital, Rangaraya medical college, Kakinada from December 2018 to December 2020. The mean follow-up Results: period was 12 months. Two patients lost follow-up. Of the remaining 28 patients, all fractures were united clinically and radiologically. At the nal follow-up the mean Constant-Murley score was 69.2 (range 50 -100). The results were excellent in 3, good in 12, fair in 10 patients, poor in 3 patients. During the follow-up 4 cases had varus mal-union, 5 had stiffness of the shoulder, 2 had supercial infection and1 had screw penetration. No cases of hardware failure, locking screw loosening or non-union were noted. T Conclusion: he divergent and convergent orientation of the locking screws of PHILOS plate provides stable biological xation with good radiological union. It minimises the soft tissue dissection and gives both axial and angular stability hence, reducing the risk of fracture displacement.

scholarly journals Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Saleh Al-wageeh ◽  
Faisal Ahmed ◽  
Khalil Al-naggar ◽  
Mohammad Reza Askarpour ◽  
Ebrahim Al-shami
Keyword(s):  
Case Report ◽  
Cause Of Death ◽  
Axial Skeleton ◽  
High Energy ◽  
Pelvic Trauma ◽  
Anterolateral Thigh Flap ◽  
Trauma Patients ◽  
Anterolateral Thigh ◽  
Life Threatening

Abstract Background Major pelvic trauma (MPT) with traumatic hemipelvectomy (THP) is rare, but it is a catastrophic health problem caused by high-energy injury leading to separation of the lower extremity from the axial skeleton, which is associated with a high incidence of intra-abdominal and multi-systemic injuries. THP is generally performed as a lifesaving protocol to return the patient to an active life. Case report A 12-year male patient exposed to major pelvic trauma with bilateral THP survived the trauma and multiple lifesaving operations. The anterolateral thigh flap is the method used for wound reconstruction. The follow-up was ended with colostomy and cystostomy with wheelchair mobilization. To the best of our knowledge, there have been a few bilateral THP reports, and our case is the second one to be successfully treated with an anterolateral thigh flap. Conclusion MPT with THP is the primary cause of death among trauma patients. Life-threatening hemorrhage is the usual cause of death, which is a strong indication for THP to save life.

scholarly journals Functional outcome of displaced proximal humerus fractures managed by proximal humerus interlocking system plate

2017 ◽  
Vol 3 (3) ◽  
pp. 583
Author(s):  
C. D. Deepak ◽  
Mahesh D. V. ◽  
Abdul Ravoof ◽  
Manash Jyoti Baruah
Keyword(s):  
Functional Outcome ◽  
Proximal Humerus Fracture ◽  
Proximal Humerus ◽  
Road Traffic ◽  
Osteoporotic Fractures ◽  
Humerus Fracture ◽  
Distal Radial Fractures ◽  
Patients Âgés ◽  
Philos Plate ◽  
The Right

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Fractures of the proximal humerus are the second most common upper extremity fracture and the third most common fracture, after hip and distal radial fractures. The fractures can occur at any age, but the incidence rapidly increases with age.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study was conducted in patients treated for displaced proximal humerus fracture at Adichunchanagiri Institute Of Medical Sciences, BG Nagar from the month of June 2014 to August 2016. Twenty proximal humerus fracture patients were taken into the study; all were fixed with PHILOS plate. Patients’ age ranged from 18 to 75 years with a mean of 42.9</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The sample consisted of twenty patients of proximal humeral fractures. 08 were males and 12 females. The patients’ ages ranged from 18-75 years with a mean age of 42.9 years. The causes of fractures were road traffic accident in 13 patients, fall in 06 patients and electric shock in 1 patient. 11 fractures involved the right side and 09 involved the left. Patients were followed up from 03 weeks to 06 months. Functional outcome was rated as per Constant-Murley Shoulder Score, we got excellent results in 04 cases, satisfactory in 10, unsatisfactory in 05 xi and failure in 01 patient. Mean Constant-Murley score of this study at the end of the final follow-up period was 81.6. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The PHILOS plate is a good implant to use for fractures of the proximal humerus. However, proper placement of the plate and fixation are required to produce satisfactory results. We recommend use of this implant in Neer 2-part, 3-part, 4-part fractures with or without dislocation and osteoporotic fractures.</span></p>

scholarly journals Internal Fixation with a Locking T-Plate for Proximal Humeral Fractures in Patients Aged 65 Years and Older

2017 ◽  
Vol 20 (4) ◽  
pp. 217-221 ◽  
Author(s):  
Jae Kwang Yum ◽  
Min Kyu Seong ◽  
Chi Woon Hong
Keyword(s):  
Postoperative Complications ◽  
Internal Fixation ◽  
Internal Rotation ◽  
Proximal Humerus ◽  
External Rotation ◽  
Osteoporotic Fractures ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
The Mean

BACKGROUND: The purpose of this study was to evaluate the clinical and radiographic outcomes of internal fixation with locking T-plates for osteoporotic fractures of the proximal humerus in patients aged 65 years and older.METHODS: From January 2007 through to December 2015, we recruited 47 patients aged 65 years and older with osteoporotic fractures of the proximal humerus. All fractures had been treated using open reduction and internal fixation with a locking T-plate. We classified the fractures in accordance to the Neer classification system; At the final follow-up, the indicators of clinical outcome-the range of motion of the shoulder (flexion, internal rotation, and external rotation) and the presence of postoperative complications-and the indicators of radiographic outcome-the time-to-union and the neck-shaft angle of the proximal humerus-were evaluated. The Paavolainen method was used to grade the level of radiological outcome in the patients.RESULTS: The mean flexion was 155.0° (range, 90°?180°), the mean internal rotation was T8 (range, T6?L2), and the mean external rotation was 66.8° (range, 30°?80°). Postoperative complications, such as plate impingement, screw loosening, and varus malunion were observed in five patient. We found that all patients achieved bone union, and the mean time-to-union was 13.5 weeks of the treatment. The mean neck-shaft angle was 131.4° at the 6-month follow-up. According to the Paavolainen method, “good” and “fair” radiographic results each accounted for 38 and 9 of the total patients, respectively.CONCLUSIONS: We concluded that locking T-plate fixation leads to satisfactory clinical and radiological outcomes in elderly patients with proximal humeral fractures by providing a larger surface area of contact with the fracture and a more rigid fixation.

scholarly journals Glucocorticoid-induced osteoporosis: presentation and comments on the new American College of Rheumatology guidelines

2018 ◽  
Vol 20 (3) ◽  
pp. 114-120
Author(s):  
Natalia V. Toroptsova
Keyword(s):  
Age Groups ◽  
Organ Transplant ◽  
Osteoporotic Fractures ◽  
High Dose ◽  
Mineral Density ◽  
First Line ◽  
American College Of Rheumatology ◽  
Over 40 Years ◽  
Very High

The article presents a review of the clinical guidelines of 2017 American College of Rheumatology for prevention and treatment of glucocorticoid-induced osteoporosis. The guidelines i contain fracture risk gradation not only for people over 40 years , based on the measurement of bone mineral density, 10-year probability of fractures by FRAX and prior osteoporotic fractures, but also for people under 40 years. The guidelines present , recommendations for initial and follow-up treatment for prevention of glucocorticoid-induced osteoporosis according the level of risk of fractures in different age groups of adults, and in children from 4 years of age, in patients with organ transplant and patients older than 30 years, receiving very high-dose of glucocorticoids . Oral bisphosphonates were recommended as first line treatment due to safety, cost, and because of lack of evidence for superior antifracture benefits from other OP medications. Oral bisohosphonates could be switched to another medication in case of intolerance. The issues of applicability of these recommendations in national clinical practice are being discussed.

scholarly journals An Overview of Tools to Score Severity in Pediatric Inflammatory Bowel Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Ron Shaoul ◽  
Andrew S. Day
Keyword(s):  
Disease Activity ◽  
Age Groups ◽  
Scoring Systems ◽  
Clinical Findings ◽  
Response To Treatment ◽  
Cochrane Library ◽  
Optimal Care ◽  
Patient Reported ◽  
Assessment Of Disease Activity

Background and Aims: The management of IBD entails the use of various treatments (nutrition, medications, and surgery) in order to induce and maintain remission. The assessment of IBD disease activity is based on a combination of symptoms, clinical findings, imaging, and endoscopic procedures. As in any disease, reliable assessment of disease activity or severity is required in order to plan relevant follow-up, decide on appropriate investigations, determine the best treatment option and subsequently assess response to treatment. It is important for proper documentation, follow-up, assessment of response to treatment and communication, especially in patients with IBD, to talk the same language by using validated and widely used scores for disease activity, endoscopic and radiologic activity, and patient reported outcomes both for clinical practice and research. This review aims to highlight key tools available for the assessment of disease activity or severity in individuals (especially children) with IBD.Methods: A literature search was performed using MEDLINE, Pubmed, and the Cochrane Library with the last search date of August 2020. Tools evaluating disease severity across various aspects (clinical, endoscopic, and radiological) were identified and discussed. Those tools validated and specific for children with IBD were included were available.Results: Over time a number of scoring systems have been developed to quantify clinical, endoscopic and imaging assessments in individuals with IBD. While some are exclusively for children or adults, others appear to have relevance to all age groups. In addition, some tools developed in adult populations are utilized in children, but have not expressly been validated in this age group.Conclusions: Although some available scoring tools are appropriate for children with IBD, others require consideration. The development and use of pediatric-specific tools is relevant and appropriate to optimal care of children and adolescents with IBD.

scholarly journals Outcome of locking plate fixation for proximal humerus fractures

2016 ◽  
Vol 2 (1) ◽  
pp. 25
Author(s):  
Neil Rohra ◽  
Jimmy Chokshi ◽  
Rishi Sanghavi
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Humerus ◽  
Evaluation Criteria ◽  
Proximal Humerus Fractures ◽  
Age Group ◽  
Philos Plate ◽  
Humerus Fractures ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate functional outcome of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> We reviewed 30 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2010 to 2015. There were 23 men and7 women with a mean age of 36 years (range 20-64).There were 22 patients in the age group of &lt;60 years and 8 patients in the age group of &gt;60 years. According to Neer classification system, 12, 11 and 4 patients had2-part, 3-part, and 4-part fractures, respectively and 2 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma center. Functional evaluation of the shoulder at final follow-up was done using Neer’s Evaluation Criteria.</span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong><span lang="EN-US"> The mean follow-up period was 20 months (range 14-40 months). All fractures united clinically and radio logically. The mean time for radiological union was 13.2 weeks (range 9-26 weeks).At the final follow-up the mean Neer’s Evaluation Criteria was 90 (range 76-100). The results were excellent in 17patients, Satisfactory in 8 patients, Unsatisfactory in 4 patients and Failure in 1 patient. During the follow-up, 3 cases of varus malunion, 1 case of failure of fixation were noted. No cases of AVN, hardware failure, locking screw loosening, infection or nonunion were noted.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong><span lang="EN-US"> PHILOS provides stable fixation in proximal humerus fractures. In order to prevent the complications like avascular necrosis, knowledge of anatomy and vascular supply of head of humerus and good surgical dissection to preserve vascularity of humeral head is important.</span></p>

scholarly journals Comparative study of functional outcome of dynamic compression plating and interlocking intramedullary nailing for fructure shaft of humerus

2017 ◽  
Vol 3 (5) ◽  
pp. 1038
Author(s):  
Aminul Islam Mamood ◽  
Ajay Kumar Mahto
Keyword(s):  
Comparative Study ◽  
Dynamic Compression ◽  
Humeral Shaft ◽  
High Rate ◽  
Trauma Patients ◽  
Humeral Shaft Fractures ◽  
Shaft Fractures ◽  
One Year ◽  
Compression Plating

<p class="abstract"><strong>Background:</strong> Fracture of the diaphysis of humerus and its complications are a major cause of morbidity in trauma patients. Fracture of the humeral shaft account for 20% of humeral fractures &amp; about 3% of all fractures. There is a debate between the choices of operation in humeral shaft fractures.</p><p class="abstract"><strong>Methods:</strong> A comparative study of management of acute humeral shaft fractures treated by Dynamic Compression Plate (DCP) and Intra Medullary Interlocking Nail (IMILN) fixation over a period of one half years. 18 patients of IMILN and 20 patients of DCP were included after considering inclusion and exclusion criteria. Functional scoring criteria were used for postoperative assessment &amp; the average follow up period was one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> A high rate of excellent &amp; good results &amp; a tendency for early union was seen with the plating group than nailing group.</p><strong>Conclusions:</strong> Plating shows better results than nailing.

Sign in / Sign up

Export Citation Format

Share Document