title: Hertel 7 fracture of the humeral head. Can two different fixation systems (Diphos/PHP) lead to different outcomes? A retrospective study.
abstract: OBJECTIVE
  To compare clinical outcomes and complication rates in the medium-to-long-term follow-up of Hertel 7 humeral head fractures treated with two different locking plates.
  
  
  METHODS
  A total of 52 patients with type 7 humeral head fracture (in accordance with Hertel classification) were enrolled retrospectively: 24 patients [4 male, 20 female; mean age (standard deviation [SD]): 68.9 (5.8) years] were treated with Diphos H plate (Group A) and 28 patients [6 male, 22 female; mean age (SD): 61.0 (7.5) years] with Proximal Humeral Plate (PHP; Group B). The mean follow-up periods were 25.6 and 18.9 months, respectively. Functional outcomes were assessed using the Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score; X-ray evaluation was also performed and complications were recorded.
  
  
  RESULTS
  The mean Constant score in the Diphos and PHP groups at follow-up were 75.6 (SD 13.4) and 78.9 (SD 12.8), respectively (p>0.05). The DASH score was similar in both groups (Diphos: 18.6, range 0-51.5; PHP: 16.8, range 0-47.8) (p>0.05). In our series, 9.6% of patients had complications; these included a case of aseptic non-union and a case of avascular necrosis of the humeral head in each group, and a secondary screw perforation in a patient treated with Diphos.
  
  
  CONCLUSIONS
  In patients with Hertel 7 proximal humeral fractures, Diphos and PHP lead to similar satisfactory functional outcomes and are associated with low complication rates; this confirms that both are useful implants for the treatment of this pattern of fracture.
authors: Section of Orthopaedics and Traumatology, Shoulder and Elbow Unit, Sapienza University, Rome, Italy. Electronic address: s.gumina@tiscali.it.
authors: S
authors: S
authors: Gumina
authors: Section of Orthopaedics and Traumatology, University of Modena, Italy.
authors: P
authors: P
authors: Baudi
authors: Section of Orthopaedics and Traumatology, Shoulder and Elbow Unit, Sapienza University, Rome, Italy.
authors: V
authors: V
authors: Candela
authors: Section of Orthopaedics and Traumatology, University of Modena, Italy.
authors: G
authors: G
authors: Campochiaro
mesh_terms: D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D058430:Humeral Head / Q000000981:diagnostic imaging / Q000473:pathology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Humeral head fractures; Internal fixation; Locking plates; Shoulder surgery; Shoulder trauma