Cement augmentation of the proximal humerus internal locking system in elderly patients: a multicenter randomized controlled trial

Abstract: Introduction Cement augmentation of the proximal humerus internal locking system (PHILOS) screws might reduce complication
rates in osteoporotic bones. This study compared the risk of mechanical failure during the first year after PHILOS™
treatment of proximal humerus fractures (PHF) without (control group) and with (augmented group) screw augmentation.
Secondary objectives were to report shoulder functions, quality of life (QoL), adverse events (AEs), and reoperation rates.
Materials and methods This multicenter randomized trial enrolled patients aged ≥ 65 years with displaced/unstable PHF
from eight European centers. Randomization was performed during surgery through sealed opaque envelopes. Mechanical
failures were assessed by two independent reviewers via radiographs, shoulder function by Quick DASH, SPADI, and Constant
Murley scores, and QoL by EQ-5D. Follow-ups were planned at postoperative 6 weeks, 3, 6, and 12 months.
Results The preliminary analysis of 6-week radiographs of the first 59 enrolled patients suggested a mechanical failure rate
lower than expected and the difference between groups was too small to be detected by the planned sample size of 144. The
trial was prematurely terminated after 67 patients had been enrolled: 34 (27 eligible) in the control group and 33 (29 eligible)
in the augmented group. Follow-ups were performed as planned. Nine patients had mechanical failures and the failure rates
(95% CI) were: augmented group, 16.1% (5.5; 33.7); control group, 14.8% (4.2; 33.7); the relative risk (95% CI) for the
augmented group was 1.09 (0.32; 3.65) compared to the control group (p = 1.000). No statistically significant differences in
shoulder function, QoL, and AEs were observed between study groups at 1 year. Nine patients (15.8%) underwent a revision.
Conclusions Due to premature termination, the study was underpowered. A larger study will be necessary to determine if
cement augmentation lowers the risk of mechanical failure rate

Angaben zum Objekt

• Standort: Deutsche Nationalbibliothek Frankfurt am Main
• Umfang: Online-Ressource
• Sprache: Englisch
• Anmerkungen: Archives of orthopaedic and trauma surgery. - 139, 7 (2019) , 927-942, ISSN: 1434-3916

Beteiligte, Orts- und Zeitangaben

• Ereignis: Veröffentlichung
• (wo): Freiburg
• (wer): Universität
• (wann): 2019
• Urheber: Hengg, Clemens ; Nijs, Stefaan ; Klopfer, Tim ; Jäger, Martin ; Platz, Andreas ; Pohlemann, Tim ; Babst, Reto ; Franke, Jochen ; Kralinger, Franz

Weitere Informationen

• DOI: 10.1007/s00402-019-03142-6
• URN: urn:nbn:de:bsz:25-freidok-1500249
• Rechteinformation: Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Letzte Aktualisierung: 25.03.2025, 13:54 MEZ