ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2020
Mid-term results of minimally invasive deltoid-split versus standard open deltopectoral approach for PHILOS™ (proximal humeral internal locking system) osteosynthesis in proximal humeral fractures.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk factors for osteonecrosis of the humeral head after internal fixation of proximal humeral fractures: a systematic review and meta-analysis.Archives of orthopaedic and trauma surgery · 2024Pooled it
- A rat traumatized shoulder model for the study of post-surgical adhesions.Bone reports · 2025Article
- Risk factors associated with secondary displacement in fractures of the humeral greater tuberosity.Frontiers in surgery · 2025Article
- The Application of Bidirectional Rapid Reductor in Minimally Invasive Plate Osteosynthesis for the Treatment of Proximal Humeral Fractures: A Case Series.Orthopaedic surgery · 2024Article
- Minimally invasive lateral plating for diaphyseal fractures with extension into the proximal humerus and its implications for the deltoid muscle and its distal insertion: functional analysis and MR-imaging.BMC musculoskeletal disorders · 2023Article
- Proximal humerus fractures: deltopectoral open reduction and internal fixation vs deltosplit minimally invasive plate osteosynthesis: which surgical approach provides superior results?EFORT open reviews · 2023Article
- An updated systematic review and meta‑analysis comparing deltoid‑split approach with deltopectoral approach for proximal humerus fractures.Experimental and therapeutic medicine · 2023Article
- PHILOS Synthesis for Proximal Humerus Fractures Has High Complications and Reintervention Rates: A Systematic Review and Meta-Analysis.Life (Basel, Switzerland) · 2022Review
- Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely - A Retrospective Study.Geriatric orthopaedic surgery & rehabilitation · 2021Article
- Long head of biceps in proximal fractures of the humerus: an underestimated problem?Acta bio-medica : Atenei Parmensis · 2020Review
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7 authors.
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Abstract
purposeOnly a few reports compare the mid- and long-term outcome of the minimally invasive deltoid split (MIDS) with the classic anterior deltopectoral (DP) approach for osteosynthesis in proximal humeral fractures. This study compared the mid-term functional and the radiological results in patients with proximal humeral fractures undergoing osteosynthesis with the proximal humeral internal locking system (PHILOS™).
methodsAll patients undergoing osteosynthesis between 2008 and 2015 were clinically and radiologically examined with a minimal follow-up period of 1 year. Functional outcomes were analyzed using the DASH- and Constant Shoulder Scores (CSS). Radiological results were analyzed using a newly developed score.
resultsThirty-nine patients underwent PHILOS™ osteosynthesis with the MIDS and twenty-three with the DP approach. Follow-up time was 41 months in the MIDS group and 62 months in the DP group, respectively. The median CSS was similar with 79 points in the MIDS group and 82 points in the DP group (p = 0.17). The MIDS group showed a significant lower power measurement in the CSS. In four-part fractures, a substantially lower CSS in absolute numbers in the MIDS group was detected. The median DASH score was 26.7 points in the MIDS group and 25.8 points in the DP group (p = 0.48). There was no difference in the radiological score. More patients with partial avascular necrosis (AVN) were found in the MIDS group, most with three- and four-part fractures. However, this was not statistically significant. Morbidity was similar between groups.
conclusionThe results of the two surgical approaches are statistically comparable. Some differences such as a lower power measurement in the MIDS group, a higher partial AVN frequency and more plate removals are observed. In four-part fractures, the CSS was lower in the MIDS compared to the DP cohort. The MIDS technique might not be a solution for all fracture types, and the surgeon should be careful to analyze the morphology of the fracture before deciding upon the approach. Four-part fractures might be better treated with a DP approach.
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