Osteosynthesis of Proximal Humeral Fractures with the Fixed Angle PHILOS-plate

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomechanics

Background:

• Proximal humeral fractures are common injuries, often resulting from falls.
• Displaced fractures, particularly 3- and 4-part patterns, present treatment challenges.
• Fixed-angle devices aim to provide stable fixation for complex fracture patterns.

Purpose of the Study:

• To evaluate the functional and radiological outcomes of proximal humeral fractures treated with the PHILOS plate.
• To assess the efficacy of the PHILOS plate in complex fracture patterns (Neer IV-VI, 3- and 4-part).
• To identify potential complications associated with PHILOS plate fixation.

Main Methods:

• Retrospective analysis of 30 patients with proximal humeral fractures treated with a PHILOS plate.
• Fracture classification using Neer system and assessment of fracture parts.
• Functional outcome assessment using Constant-Score, normalized Constant-Score, and UCLA-Score.
• Radiological assessment for union, avascular necrosis, screw perforation, malunion, and varus displacement.

Main Results:

• Good to excellent results reported in 66.7% (Constant-Score) to 76.7% (UCLA-Score).
• 86.7% of patients experienced no or mild pain, with similar rates for active motion >90°.
• Complications included partial avascular necrosis (13.3%), screw perforation (10%), and secondary varus displacement (63.3%).

Conclusions:

• PHILOS plate fixation is an adequate treatment for displaced 2- to 4-part proximal humeral fractures.
• The device demonstrates good functional and radiological outcomes, even in complex or dislocated fractures and in patients over 65.
• While effective, potential complications such as varus displacement and avascular necrosis should be monitored.