The Clinical Effects Of Internal Fixation With PHILOS In The Treatment Of Complex Proximal Humeral Fractures Via A Subacromial Minimally Invasive Approach

Objective: To investigate the clinical effects of internal fixation with proximalhumeral internal locking system（PHILOS) in the treatment of complex proximalhumeral fractures via a subacromial minimally invasive approach． To explore thepostoperative complications and the related risk factors for complex proximalhumeral fractures treated with this surgical approach, and to propose thecorresponding countermeasures.Methods: Between January2009and December2011,106cases with complexproximal humeral fractures treated in our department were retrospectivelyanalyzed. The posoperative shoulder function was evaluated using Constant scoreand DASH score system, the quality of life of patients was evaluated using theEuropean five-dimensional Health Questionnaire (EQ-5D), the postoperativecomplications were recorded. The relationship between postoperativecomplications and the related risk factors was analyzed by means of Logisticregression analysis.Results:81patients received more than12months of follow-up.12months afterthe operation, the mean Constant score was76.6±4.7points, the DASH score was24.2±9.7points, the EQ-5D index score was0.72±0.07, and the mean EQ-VASscore was83.5. The postoperative complications occurred in31patients (38.3%)of which impingement syndrome involved in16cases (19.8%), head-shaft angle loss in six cases (7.4%), head-shaft angle loss combined with screws cut-out intwo cases (2.5%), pure screws cut-out in two cases (2.5%), humeral head necrosisin two cases (2.5%), fat liquefaction in five cases (6.2%).There is no axillarynerve damage, nonunion, fracture fixation loosening, and deep infections case.Single factor analysis showed that there were significant differences in thesuperiorly located greater tuberosity, superiorly located plate and Neerclassification between impingement group and un-impinged group (P <0.05).There were statistically significant differences in age, postoperative medialcortical defects and Neer classification between head-shaft angle loss group andun-loss group (P <0.05). By means of logistic regression analysis, the superiorlylocated greater tuberosity, superiorly located plate and Neer classification werethe individual predictors for postoperative impingement syndrome; postoperativemedial cortical defect and Neer classification were the individual predictors forpostoperative head-shaft angle loss.Conclusion:1. Internal fixation with PHILOS via a subacromial minimally invasive approachis a safe and effective method for complex proximal humeral fractures, whichenabling the patient to obtain a relatively satisfactory shoulder function andquality of life.2. There is a certain incidence of complications in the internal fixation withPHILOS via a subacromial minimally invasive approach for complex proximalhumeral fractures. The incidence of postoperative impingement and loss ofhead-shaft angle is relatively high.3. Superiorly located greater tuberosity, superiorly located plate and Neerclassification were the individual predictors for postoperative impingementsyndrome; postoperative medial cortical defect and Neer classification were the individual predictors for postoperative head-shaft angle loss.