Philos plate

Sixteen well-trained orthopedic surgeons performed all the operations. We placed patients in a “beach chair” position on an operating table under general anesthesia. The fracture site was exposed using the deltopectoral approach. Nonabsorbable sutures were passed through the junction of the tuberosities and rotator cuff to promote mobilization and reduce tuberosities. An adequate fibular strut was inserted into the intramedullary canal through the fracture site and medialized toward the calcar to reduce the column in patients with a comminuted medial hinge or severe osteoporosis. Subsequently, the humeral head and shaft were reduced. Once reduction was confirmed with a C-arm X-ray machine after temporary fixation, the plate (Philos plate; DePuy Synthes, Oberdorf, Switzerland; 3.5 mm LCP proximal humerus plate, IRENE, Tianjin, China) was fixed with screws. Final confirmatory orthogonal X-rays were used to show the position of the plates and screws and fracture reduction. We used No.2 Ethibond sutures to fix the tuberosities, which passed through the junction of the rotator cuff and the tuberosities. Additional supplementary tuberosity screws were used, if necessary. After testing for shoulder activity, the wound was closed.

This multi-centric prospective study investigated shoulder activity with accelerometer-based trackers during the first six postoperative weeks in elderly patients with a complex proximal humerus fracture treated with the PHILOS plate (DePuy Synthes, Zuchwil, Switzerland). The two study centers were the University Hospitals Leuven and Medical University Innsbruck. Note that the study sites will be referred to in an anonymized manner below. The study was approved by the local ethical committees (approval numbers S62376 and 1281/2018, respectively).

The final data set comprised 58 patients (male: 26, female: 32) with a mean age of 55.6 ± 14.4 years (range: 17.7 to 101.3 years, age at surgery). All patients were followed up at least six years (7.9 ± 1.4 (range: 6.2 to 11.1 years) after surgical intervention. According to the Neer classification [13 (link)], the cohort consisted of 24 2-part fractures, 25 3-part fractures, and 9 4-part fractures. According to the AO/OTA classification [14 ], these fractures were classified as 24 A, 22 B, and 12 C fractures. All fractures were treated with an angular stable plate (PHILOS® plate, DePuy Synthes, West Chester, Pennsylvania, USA or Non-Contact Bridging plate, Zimmer, Germany GmbH, Freiburg, Deutschland, or 4.5-mm T-plate (Stratec Medical, Oberdorf, Schweiz).

The final data set comprised 90 patients (male: 12, female: 78; height: 164.8 ± 7.2 cm; weight: 68.9 ± 17.8 kg) with a mean age of 78.1 ± 5.2 years (range 70.1 to 89.8 years). According to the Neer classification [20 (link)], the cohort consisted of 34 2-part fractures, 41 3-part fractures, and 12 4-part fractures. According to the AO/OTA classification [21 ], these fractures were classified as 34 A, 32 B, and 21 C fractures. No traumatic nerve injury or vascular comorbidities occurred. Fractures were treated in 28.9% of the cases with a PHILOS® plate (DePuy Synthes, West Chester, Pennsylvania, USA) and in 71.1% of the cases with a WINSTA-PH WS proximal Humerus (Axomed GmbH, Freiburg, Germany).