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Medical Science Monitor Basic Research


eISSN: 1643-3750

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Assessment of Screw Length of Proximal Humerus Internal Locking System (PHILOS) Plate for Proximal Humeral Fractures Using Three-Dimensional Computed Tomography Scan

Minfei Qiang, Xiaoyang Jia, Yanxi Chen, Kun Zhang, Haobo Li, Yuchen Jiang, Yijie Zhang

(Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland))

Med Sci Monit 2018; 24: CLR1158-1165

DOI: 10.12659/MSM.906355

BACKGROUND: Screw perforation and varus collapse are common complications of treatment with a PHILOS (proximal humerus internal locking system) plate for proximal humerus fractures, which are associated with improper screw length selection and lack of medial column support. The purposes of this study were: (1) to measure the proper length of periarticular screws of the PHILOS plate in the humeral head, and (2) to determine what factors influence the screw length and implantation of the inferomedial support screw.
MATERIAL AND METHODS: Computed tomography (CT) images of the normal proximal humerus in 134 cases were retrospectively reviewed. The length of periarticular screws was measured using three-dimensional (3D) techniques. Intraobserver and interobserver reliability of measurement were evaluated using intraclass correlation coefficients (ICCs). Sex and body height influences on screw length and implantation of the inferomedial screw were analyzed.
RESULTS: All measurements had excellent agreement (ICC>0.75). The screw length and implantation rate of the inferomedial screw were greater in males than in females. Positive correlations were observed between body height and screw length and implantation of the inferomedial screw (all P<0.001).
CONCLUSIONS: The screws were longer and the implantation rate was higher for inferomedial screws in males than in females, and were positively correlated with body height. Our data can be used as a reference for surgeons to reduce the number of times screws are changed intraoperatively and to reduce operation duration and minimize use of intraoperative fluoroscopy for proximal humerus fractures treated with the PHILOS plate.

Keywords: Bone Screws, Image Processing, Computer-Assisted, Imaging, Three-Dimensional, multidetector computed tomography, Shoulder Fractures

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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