Comparison of the clinical outcomes and radiological parameters between the greater tuberosity strengthened proximal humeral plate and the proximal humeral internal locking system plate in the minimally invasive plate osteosynthesis treatment of proximal humeral fractures involving the greater tuberosity: a retrospective cohort study.

backgroundWith the gradual promotion of minimally invasive plate osteosynthesis (MIPO) in the treatment of proximal humeral fractures, some patients using the proximal humeral internal locking system (PHILOS) plate experience significant displacement of the fixed greater tuberosity. However, this is rarely seen in patients using a new plate named the greater tuberosity strengthened proximal humeral plate (GTSPHP). Notably, a comparison of these two plates is lacking. Therefore, we aimed to retrospectively compare the clinical outcomes and radiological parameters of MIPO using the GTSPHP and PHILOS plates.

methodsThe data of 40 patients with proximal humeral fractures involving the greater tuberosity who underwent MIPO performed by the same physician between 1 April 2019 and 31 December 2022 were retrospectively analysed. Sixteen and 24 patients were included in the GTSPHP and PHILOS plate groups, respectively and followed up for at least 1 year postoperatively. General clinical characteristics, perioperative data, postoperative follow-up clinical outcomes, complications, and reduction loss of the greater tuberosity were compared between the two groups.

resultsNo significant differences were found in age, sex, affected side, injury mechanism, fracture type, injury to surgery time, operative time, postoperative hospital stay, the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) score, and Constant score between the two groups. However, the GTSPHP group was superior to the PHILOS plate group regarding surgical incision length, intraoperative blood loss, and the 11-point numerical rating scale score on the first, second and third postoperative days. In the PHILOS plate group, three patients had fracture malunion; both groups showed no signs of incision infection, fracture non-union, screw cut-out, or subacromial impingement syndrome. Both groups showed no significant differences in complication rates. The risk of reduction loss of greater tuberosity was lower in the GTSPHP group than in the PHILOS plate group.

conclusionsOur study showed that in MIPO treatment of proximal humeral fractures involving the greater tuberosity, the GTSPHP outperformed the PHILOS plate in terms of intraoperative blood loss, surgical incision length, short-term postoperative pain, and fixation capability of the greater tuberosity. However, further research is needed to confirm these findings. CLINICAL TRIAL NUMBER: Not applicable.