Fractures of the humerus have challenged medical practitioners since the beginning of recorded medical history. In the earliest known surgical text, The Edwin Smith Papyrus (copied circa 1600 BC), three cases of humeral fractures were described. Reduction by traction followed by bandaging with linen was recommended. In Corpus Hippocraticum (circa 440–340 BC), the maneuver of reduction was fully described: bandages of linen soaked in cerate and oil were applied followed by splinting after a week. In The Alexandrian School of Medicine (third century BC), shoulder dislocations complicated with fractures of the humerus were mentioned and the author discussed whether the dislocation should be reduced before or after the fracture. Celsus (25 BC–AD 50) distinguished shaft fractures from proximal and distal humeral fractures. He described different fracture patterns, including transverse, oblique, and multifragmented fractures. In Late Antiquity, complications from powerful traction or tight bandaging were described by Paul of Aegina (circa AD 625–690). Illustrations from sixteenth and seventeenth century surgical texts are included to show the ancient methods of reduction and bandaging. The richness of written sources points toward a multifaceted approach to the diagnosis, reduction, and bandaging of humeral fracture in Ancient Egypt, Greece, and Rome.
Professional secrecy of doctors became an issue of considerable medico-legal and political debate in the late nineteenth and early twentieth centuries in both Germany and England, although the legal preconditions for this debate were quite different in the two countries. While in Germany medical confidentiality was a legal obligation and granted in court, no such statutory recognition of doctors’ professional secrecy existed in England. This paper is a comparative analysis of medical secrecy in three key areas - divorce trials, venereal disease and abortion - in both countries. Based on sources from the period between c.1870 and 1939, our paper shows how doctors tried to define the scope of professional secrecy as an integral part of their professional honour in relation to important matters of public health.
medical confidentiality; professional secrecy; medical ethics; medicine and law; venereal diseases; abortion; public health; England; Germany
Despite a varied historical literature on the nineteenth-century royal dockyards, very little has been written about the health issues associated with naval shipbuilding or the healthcare facilities that were provided for dockworkers in the period. This article focuses mainly on the latter. Drawing on archival sources from the home dockyards, an examination is made of the duties and responsibilities of dockyard surgeons. These are found to have expanded considerably as healthcare provision became steadily more comprehensive. It is argued that as providers to a civilian workforce, the naval authorities were in the vanguard when it came to implementing perceived advances in medical practice. It is also contended, however, that while many dockworkers benefited as a result, this positive appraisal needs to be set against the more ambiguous aspects of the surgeon’s role. Although surgeons treated the sick and injured, their growing prominence in other dockyard matters, such as retirement and the policing of sickness, is shown to have created tension in their relationship with the workforce.
Royal dockyards; Surgeon; Royal Navy; Healthcare; Dockworkers; Shipbuilding
Posterior shoulder fracture-dislocation is a rare emergency condition with poor prognosis when there is a delay in diagnosis and presence of associated injuries.
We present a case of a neglected four-part fracture-dislocation of the proximal humerus in a 34-year-old Greek woman. Except from the substantially displaced and comminuted tuberosity fractures, an anterolateral defect of approximately 50% of the articular surface was apparent. Open reduction of the humeral head was followed by reconstruction of the proximal humerus with allograft impaction, transfer of lesser tuberosity to the humeral defect and anatomic fixation of the greater tuberosity and humeral neck fractures. At two and a half years postoperatively, the humeral head was revascularised and properly articulated with the glenoid fossa.
The presented case underlines the variability of injury pattern, the potential of missed diagnosis and the need for preserving the humeral head in young patients regardless of the amount of articular surface defect and disruption of soft tissue attachments.
Simultaneous supracondylar humerus fracture and ipsilateral fracture of the proximal humerus in children is rare.
A 10-year-old Turkish boy with an extension type supracondylar humerus fracture and ipsilateral fracture at the proximal metaphyseal-diaphyseal junction of the humerus was treated by closed reduction and percutaneous Kirschner wire fixation. Closed reduction was performed using a Kirschner wire as a "joystick" to manipulate the humeral shaft after some swelling occurred around the elbow and shoulder.
The combination of fractures at the proximal and distal parts of the humerus can be termed as "floating arm" injury. Initial treatment of this unusual injury should be focused on the supracondylar humerus fracture. However, closed reduction can be difficult to perform with the swelling around the elbow and shoulder. A temporary Kirschner wire can be used as a "joystick" to fix and reduce the fracture.
AIM: To describe 19th century amputations carried out at the Royal Berkshire Hospital, Reading. METHODS: A retrospective analysis of hospital archives. RESULTS: Details of 276 amputations were analysed. The majority (86%) were in men and boys. The median age was 33 years. The ratio of leg:arm amputation was 2:1. Trauma accounted for 58% of amputations. Of 52 arm amputations, 42 were due to trauma, compared with 37 of 110 leg amputations (P < 0.001). Mortality was higher following amputation for trauma than for disease (P < 0.01). Mortality following leg amputation was 16% compared with 3.8% after arm amputation (P < 0.05). Death rate following compound fracture was 23%. CONCLUSIONS: Compared with today, the population undergoing amputation and the indications for amputation in the 19th century differ significantly. However, it is apparent that in those patients who were selected to undergo amputation acceptable survival figures could be achieved.
During the late nineteenth century, many British physicians rigorously experimented with hypnosis as a therapeutic practice. Despite mounting evidence attesting to its wide-ranging therapeutic uses publicised in the 1880s and 1890s, medical hypnosis remained highly controversial. After a decade and a half of extensive medical discussion and debate surrounding the adoption of hypnosis by mainstream medical professionals – including a thorough inquiry organised by the British Medical Association – it was decisively excluded from serious medical consideration by 1900. This essay examines the complex question of why hypnosis was excluded from professional medical practice by the end of the nineteenth century. Objections to its medical adoption rarely took issue with its supposed effectiveness in producing genuine therapeutic and anaesthetic results. Instead, critics’ objections were centred upon a host of social and moral concerns regarding the patient’s state of suggestibility and weakened ‘will-power’ while under the physician’s hypnotic ‘spell’. The problematic question of precisely how far hypnotic ‘rapport’ and suggestibility might depart from the Victorian liberal ideal of rational individual autonomy lay at the heart of these concerns. As this essay demonstrates, the hypnotism debate was characterised by a tension between physicians’ attempts to balance their commitment to restore patients to health and pervasive middle-class concerns about the rapid and ongoing changes transforming British society at the turn of the century.
Hypnosis; Suggestibility; Doctor–Patient Relations; Victorian Medicine; Psychical Research
Culture not only justifies the existence of libraries but also determines the level of funding libraries receive for development. Cultural appreciation of the importance of libraries encourages their funding; lack of such appreciation discourages it. Medical library development is driven by culture in general and the culture of physicians in particular. Nineteenth-century North American medical library funding reflected the impact of physician culture in three phases: (1) Before the dawn of anesthesia (1840s) and antisepsis (1860s), when the wisdom of elders contained in books was venerated, libraries were well supported. (2) In the last third of the nineteenth century, as modern medicine grew and as physicians emphasized the practical and the present, rather than books, support for medical libraries declined. (3) By the 1890s, this attitude had changed because physicians had come to realize that, without both old and new medical literature readily available, they could not keep up with rapidly changing current clinical practice or research. Thus, “The Medical Library Movement” heralded the turn of the century.
Some evidence is assembled to suggest that trench fever, an infection with a strain of Rochalimaea, if not quintana, then vinsonii, was present in Belfast in the first half of the nineteenth century in endemic and epidemic form. It may have amounted at times to one half or more of 'fever'. This may account for the comparatively low mortality in some years from 'fever'. The phrase 'relapsing fever' in the nineteenth and twentieth century medical literature of the United Kingdom should not be taken necessarily to mean infection with Borrelia recurrentis. Much or most may have been infection with Rochalimaea, quintana or vinsonii. The newly discovered Irish vole should be examined to see if it carries a Rickettsia or Rochalimaea infection.
While Jewish ritual circumcision continues to be a controversial issue in Europe and the US, metzitzah b’peh, the addendum to brit milah, which requires the mohel (ritual peritomist) to orally suck blood from the wound immediately following the excision of the foreskin, remains a divisive topic. While medical historians have studied European outbreaks of infectious disease following metzitzah b’peh, no one has assessed the response of the nineteenth century New York Jewry. This paper analyses how this nascent community responded to the thorough report by the New York Board of Health following an alleged and discredited outbreak of syphilis attributed to metzitzah b’peh in 1873, especially in the context of nineteenth century immigration, popular perception of syphilis and American medicine.
Ritual Circumcision; Metzitzah b’peh; Syphilis; Syphilophobia; Mohel; Lower East Side
Fractures of the humeral head account for 5% of all fractures and incidence increases with age. Depending on fracture form and patients age a wide variety of therapeutical options exist. Stable fractures can be treated conservatively, while the majority of unstable and displaced fractures require surgical treatment. Many different surgical options are available; open reduction and internal fixation are widely preferred. The S3 Proximal Humerus Plate is a contoured plate to match the complex shape of the proximal humerus. It is designed to be positioned distal to the greater tuberosity preventing subacromial impingement.
Between august 1 and 30, 2007, 5 patients meeting the inclusion criteria (that is primary operative stabilization within 7 days after trauma in a standardized way and minimal follow up period of 3 month) with acute fractures of the proximal humerus were treated with S3 Proximal Humerus Plate. Follow up was performed using the Constant Score. The mean age was 59.0 years. According to the Neer classification fractures were rated as Neer 2,3 and 4. A mean Constant score of 72.3 (57-86) points was obtained.
We did not observe any complications like humeral head necroses, loss of reduction, deep infection or breakage of the plate.
S3 proximal humerus plate; proximal humerus fracture; subchondral support pegs; fixed-angle plate fixation.
It was the Apothecaries Act of 1815 which led to the emergence of general practice as we know it today and it was this one Act which produced a flood of changes on the medical scene that are without parallel in our history. Students were soon to undergo new forms of training in new medical schools and hospitals, and many medical associations and journals were founded. The term `general practitioner' was soon in use. The driving force behind all these changes was the Society of Apothecaries and the new general practitioners, and all too often they were opposed by the two Royal Colleges. It was only at the beginning of the twentieth century that these new practitioners were allowed to call themselves `doctors'.
The historiography of medicine in South Asia often assumes the presence of preordained, homogenous, coherent and clearly-bound medical systems. They also tend to take the existence of a medical ‘mainstream’ for granted. This article argues that the idea of an ‘orthodox’, ‘mainstream’ named allopathy and one of its ‘alternatives’ homoeopathy were co-produced in Bengal. It emphasises the role of the supposed ‘fringe’, ie. homoeopathy, in identifying and organising the ‘orthodoxy’ of the time. The shared market for medicine and print provided a crucial platform where such binary identities such as ‘homoeopaths’ and ‘allopaths’ were constituted and reinforced. This article focuses on a range of polemical writings by physicians in the Bengali print market since the 1860s. Published mostly in late nineteenth-century popular medical journals, these concerned the nature, definition and scope of ‘scientific’ medicine. The article highlights these published disputes and critical correspondence among physicians as instrumental in simultaneously shaping the categories ‘allopathy’ and ‘homoeopathy’ in Bengali print. It unravels how contemporary understandings of race, culture and nationalism informed these medical discussions. It further explores the status of these medical contestations, often self-consciously termed ‘debates’, as an essential contemporary trope in discussing ‘science’ in the vernacular.
Scientific Medicine; Debate; Vernacular; Medical Correspondence; Medical System; Orthodoxy
For historians of medicine, the professor Theodor Billroth of the University of Vienna was the leading European surgeon of late nineteenth century and the personification of intervention by organ or body part removal. For social and political historians, he was a German nationalist whose book on medical education heralded the rise of anti-Semitism in the Austrian public sphere. This article brings together and critically reassesses these two hitherto separate accounts to show how, in a period of dramatic social and political change, Viennese surgery split into two camps. One, headed by Billroth, was characterized by an alliance with the German educational model, German nationalism leading to racial anti-Semitism and an experimental approach to the construction of surgical procedure, which heavily relied on the methods of pathological physiology. The other, which followed a long Austrian tradition, stood for a clinically-oriented and strictly organized medical education that catered to an ethnically and socially diverse population and, simultaneously, for an anatomically oriented surgery, largely of the locomotor apparatus. This study shows how, in a major centre of medical education and capital of a multiethnic empire, surgical and national identities were forged together.
surgery; Vienna; nationalism; medical education; Austro-Hungarian Empire
This paper describes the nineteenth-century movement to establish medical libraries in Texas. It is concerned mostly with pre-origin efforts rather than with actual achievements. It is hoped that this study will provide the background for histories of the libraries which finally evolved as a result of the earlier effort and interest.
Compared to today, ulceration of the legs was much more common in the eighteenth and early nineteenth centuries and occurred in much younger people. The evidence for this, based mainly on the records of the hospitals, the dispensaries and medical records of the navy and army, is discussed. It is likely that the underlying pathology was much more varied in the past, with the possibility that ascorbic acid deficiency played a significant part in the high frequency of leg ulcers.
Locking plates have become a commonly used fixation device in the operative treatment of three- and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures.
We compared functional scores, ROM, and radiographs in patients with one-part proximal humerus fractures treated nonoperatively to those in patients with displaced three- and four-part proximal humerus fractures treated with open reduction and internal fixation using locking plates.
Patients and Methods
We retrospectively reviewed 142 patients with proximal humerus fractures treated with a standardized treatment algorithm over a 6-year period. Three- and four-part fractures were treated surgically while one-part fractures were treated nonoperatively. Functional scores, ROM, and radiographs were used to evaluate outcomes. American Shoulder and Elbow Surgeons and SF-36 scores were obtained at 12 months. Of the 142 patients, 101 (51 with three- or four-part fractures and 50 with one-part fractures) had a minimum followup of 12 months (average, 19 months; range, 12–64 months).
The fractures united in all patients. At 1 year, the patients with one-part fractures had better SF-36 physical and mental scores and American Shoulder and Elbow Surgeons scores than the three- and four-part fractures. Both groups had similar shoulder ROM. Nine patients treated operatively had complications, four of which were related to screw penetration into the joint.
Patients with three- and four-part fractures should be advised of the likelihood of persistent functional impairment and a relatively higher risk of complications when treated operatively with locked plates.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Proximal humeral fractures account for 4–5% of all fractures; most of them involving elderly and osteoporotic people. 1 51% of such fractures are displaced. Two Fractures with minimal displacement, regardless of the number of fracture lines, can be treated with closed reduction and early mobilization, but anatomical reduction in displaced fractures is difficult to obtain and the incidence of pseudarthrosis is high 3-5. We evaluated the functional results of closed Neer's 2- and 3-part proximal humerus fractures treated by Joshi's external stabilizing system.
Materials and Methods:
Sixteen patients with proximal humeral fractures were managed from 2008 to 2010 by Joshi's stabilizing external fixation. They were 10 males and 6 females, with a mean age of 57.5 years. Based on Neer's classification, there were eleven 3-part fractures and five 2-part fractures. The mechanism of injuries included seven road traffic accidents and nine fall. Shoulder mobilization exercises were started within 1 week after stabilization with JESS. External fixation was removed after the evidence of union (6–8 weeks). Pain was evaluated by visual analogue scale (VAS) and shoulder range of motion was evaluated by Constant Scoring System. Followup was done at 4 weeks, 8 weeks, 12 weeks, and then at every 4 weeks.
Mean followup was of 20.5 months (range 9-30 months). Postoperative mean VAS score and Constant Score of patients was 2.1 (±0.73) and 78.1 (±9.61) at an average followup of 6 months. Mean duration for union was 6.5 (±1.18) weeks. One case of K-wire loosening and one case of pin tract infection were the complications noted.
External fixation by JESS is an alternative option to treat Neer's 2 and 3 part proximal humerus fractures with good results.
External fixation; Joshi's external stabilizing system; proximal humerus fractures
The aim of this study is to evaluate whether two 3.0 mm Schanz screws in two-part proximal humeral fractures (plus one additional Schanz screw or K wire in three-part fractures) can provide enough stability to allow early mobilization until healing occurs in elderly patients.
Settings and Design:
This prospective study was performed in the Orthopaedic Department of our University Hospital.
Patients and Methods:
We performed closed reduction and percutaneous pinning for thirty-three patients with proximal humerus fractures. Twenty-seven patients were available for the final follow-up. Of those 27 patients, 17 had two-part surgical neck fractures; while 10 had three-part fractures. For fixation, we used two 3.0 mm Schanz screws in patients with two-part fractures plus one additional Schanz screw or K wire in the 10 patients with three-part fractures.
The mean Constant score modified according to the age and sex was 89.8% (range: 77.3-97.2%). Fifteen patients had excellent results, 11 patients had good results, and one patient had a fair result.
Closed reduction and percutaneous pinning with two Schanz screws for two-part surgical neck humeral fractures, plus an additional Schanz screw or K wire for three-part proximal humeral fractures is a useful and effective technique that provides enough stability to allow an early rehabilitation program till union occurs in elderly patients.
Level of Evidence:
IV; therapeutic study, case series.
Early rehabilitation; proximal humerus fracture; Schanz screws
Osteoporotic fractures are now a social problem for incidence and costs. Fractures of the proximal humerus events are frequent and constantly increasing. It is estimated that they are 20% of all osteoporotic fractures. Bone densitometry in most cases underestimates the real humeral bone density.
There is little information about osteoporotic changes in the proximal humerus and their association with the cortical thickness of the humeral shaft. The ratio between the thickness of the cortical and the total diameter of the humeral diaphysis is the cortical index. Fracture risk limit value is 0.231. Convinced of the need to quantify in a reproducible way the real local humerus bone density, we performed a comparative evaluation of bone density of the humerus and femur in patients admitted to our clinic for fractures of the humerus and femur.
We evaluated 28 women treated surgically for a fragility fracture of the proximal humerus or femur neck in 2010. All cortical index obtained were lower than the limit for fracture risk set at 0.231, so the IC was more predictive of neck medial fractures of the femur than had DEXA and the U.S. The information about the cortical index may provide a simple way of determining the bone quality of the proximal humerus and of facilitating decision-making in the surgical treatment of patients with fractures of the humerus. So we want to emphasize the importance of therapy for osteoporosis even in patients with fractures of the proximal humerus, which often have not critical densitometric values of femur or column, but they are at risk of new fractures.
osteoporosis; cortical humerus index; prediction
Proximal humeral fractures occur frequently. Displaced or unstable fractures require open reduction and internal fixation. Our objective was to investigate the clinical and radiographic results of the internal fixation using Polarus humeral nails for fractures of the proximal humerus.
Materials and methods
From January 2001 to April 2006, 54 shoulders of 54 patients (44 females, 10 males) underwent the intramedullary fixation using Polarus humeral nail. Mean age of the patients was 66-year-old (39–89) at the time of the surgery. Fracture-type by Neer classification was 2-part (29 shoulders), 3-part (22 shoulders) and 4-part (3 shoulders). The clinical and radiological outcomes were evaluated.
All the shoulders after osteosynthesis obtained bone-union. There was no osteonecrosis of the humeral head. Functional outcome measured by JOA score averaged 81 points. Totally 43 patients (79%) had satisfactory to excellent results. Varus deformity was seen in 4 shoulders (8%) and the deformity of the greater tuberosity in 4 (8%).
The Polarus intramedullary humeral nail is effective for the treatment of proximal humeral fractures.
Proximal humeral fracture; Internal fixation; Clinical result
Proximal humerus fractures in the pediatric population are a relatively uncommon injury, with the majority of injuries treated in a closed fashion due to the tremendous remodeling potential of the proximal humerus in the skeletally immature. Yet, in adolescent patients, open treatment is, at times, necessary due to unsatisfactory alignment following a closed reduction, loss of previously achieved closed reduction, and limited remodeling when close to skeletal maturity. The purpose of our study was to examine the open reduction of adolescent proximal humerus fractures.
A retrospective review of the outcomes of proximal humerus fractures in the adolescent population which were consecutively treated at our institution with open reduction was performed.
Ten children met the inclusion criteria, with a mean age of 14.3 years (±1.3) and a mean weight of 60.7 kg (±14.9) at the time of injury. There were seven Salter-Harris 2 fractures and three Salter-Harris 1 fractures. The largest mean angulation was 55.0° (±33.9) and the largest mean displacement was 87.0 % (±22.8). Intra-operatively, impediments to closed reduction within the fracture site which were found included: periosteum (90.0 %), biceps tendon (90.0 %), deltoid muscle (70.0 %), and comminuted bone (10.0 %). K-wire fixation was most commonly used (70.0 %), followed by flexible nails (20.0 %) and cannulated screws (10.0 %) for fixation. All patients achieved radiographic union at a mean of 4.0 weeks (±0.7), had non-painful full shoulder range of motion and rotator cuff strength at final follow-up (mean 7.7 ± 4.6 months), and returned to pre-injury sporting activities.
The operative treatment of proximal humerus fracture, particularly in adolescents with severe displacement/angulation having failed closed methods of treatment, is increasingly considered to be an acceptable modality of treatment. In addition to the long head of the biceps, periosteum, deltoid muscle, and bone fragments in combination can prevent fracture reduction. Surgeon preference and skill should dictate implant choice, and the risk of physeal damage utilizing these implants in this age group is low.
Proximal humerus; Pediatric; Adolescent; Open reduction; Operative
Simultaneous bilateral four-part proximal humeral fractures are rare. Four-part fractures of the proximal humerus are difficult for the patient and technically demanding for the surgeon. Our surgical tactic is to attempt open reduction and internal fixation where possible. We report the functional outcome in a 56-year-old female who sustained simultaneous bilateral four-part proximal humeral fractures after falling down a flight of stairs. Open reduction and internal fixation using threaded pins and tension band suture was performed on one side, and shoulder replacement hemiarthroplasty was required on the other. Functional assessment was undertaken at two years after surgery, using the Oxford Shoulder Score. Although the objective outcomes assessment revealed little difference, the patient herself expressed a preference for the side treated by internal fixation. We conclude that an attempt to retain the native humeral head and the surgical tactic that favours internal fixation where possible is appropriate in these injuries. Excellent function can be achieved following hemiarthroplasty for trauma in a fit patient.
Locking plate fixation of proximal humeral fractures improves biomechanical stability. It has expanded the indications of traditional open reduction internal fixation and become increasingly common for treating unstable, displaced proximal humeral fractures. Despite improved stability it is unclear whether these improve function and if so for which patients.
We therefore determined patient function after a locked plating technique for the treatment of unstable proximal humeral fractures based on age, time, fracture pattern, and associated injures.
Patients and Methods
We retrospectively reviewed 66 patients with 69 proximal humeral fractures treated with a locked proximal humeral plating technique from 2002–2006 using prospectively gathered data. Function was measured using the Short Musculoskeletal Function Assessment (SMFA), Disability of the Arm, Shoulder, and Hand (DASH), and SF-36 at 6, 12, and 24 months. Fracture healing was determined radiographically and complication rates were determined from the medical records.
At 2 years, DASH scores were 26.5 and 37.4 for isolated and polytrauma patients, respectively. For age differences, DASH scores were 33.1 and 28.9 for ages younger than 60 and 60 years old or older, respectively. At 2 years, SMFA scores were higher (worse) in older compared with younger patients. Function, but not bother continues to improve in younger patients up to 2 years. More severe fracture patterns performed worse in all SMFA indices at 2 years. Polytrauma patients consistently experienced worse mobility than isolated injury patients at each time interval.
With locked plating of unstable proximal humeral fractures, older patients function as well as younger patients; improvement continues until 1 year postoperatively, the Neer fracture classification differentiates function, and polytrauma patients perform worse clinically. Long-term functional deficits persist.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
The aim of this study was to compare the functional outcome, quality of restoration, and complication rate after open reduction and internal fixation (ORIF) of displaced or unstable 2-, 3- and 4-part humeral fractures using two different locking plates.
The data used in this analysis was prospectively collected in two large multicentre studies in 15 European Level 1 trauma centres. A total of 318 patients with proximal humeral fractures were treated with ORIF using either the locking proximal humerus plate (LPHP) or proximal humeral internal locking system (PHILOS). Outcome measurements included Constant and Neer scores, evaluation of local pain at the fracture site and complications, and radiographic assessment at one year.
At one year, the mean Constant scores (relative to the contralateral shoulder) improved significantly for both groups and were above 80% for 2-, 3-, and 4-part fractures. A significantly shorter surgical time, less pain at the fracture site, and better functional outcome was achieved by PHILOS-treated patients with 2-part fractures throughout the one-year follow-up month and with 3-part fractures at three months (p < 0.05). There was no difference between the treatment outcomes for 4-part fractures, and no difference in the complication rates (p > 0.05).
PHILOS and LPHP can be considered as useful implants for ORIF of displaced and unstable proximal humeral fractures. There was a slight advantage of the PHILOS system with regard to operative time and functional outcome, especially for the treatment of 2- and 3-part fractures.
Medicine & Public Health; Orthopedics