PHILOS (Proximal Humerus Internal Locking System) Plating vs MultiLoc Nailing in Proximal Humerus Fracture:...

Proximal humeral fractures, predominantly affecting the elderly, pose significant treatment challenges due to the complex anatomy of the shoulder joint and variability in bone quality. MultiLoc nails (Synthes USA Products, West Chester, USA) are the latest construct, and PHILOS (Proximal Humerus Internal Locking System, (Synthes USA Products, West Chester, USA)) plates are the earlier construct used for the fixation of proximal humerus fractures. This systematic review aims to provide a comparison of MultiLoc nails and PHILOS plates, focusing on their effectiveness, safety, and patient outcomes. Our study included randomized controlled trials (RCTs) and observational studies comparing the effectiveness of MultiLoc nails and PHILOS plates. We searched literature in databases, including PubMed, EMBASE, and Web of Science, until December 20, 2023. The primary outcome of focus was the Neck Shaft Angle, supplemented by a range of secondary surgical and functional outcomes. The Nested Knowledge web software (Nested Knowledge, Inc., Saint Paul, USA) facilitated the screening and data extraction processes. The quality of included studies was assessed using the Cochrane Risk of Bias tool for RCTs (Cochrane, London, UK) and the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool for observational studies (Cochrane, London, UK). R software version 4.3 (R Foundation for Statistical Computing, Vienna, Austria) was used to synthesize the collected data. Six studies met the inclusion criteria, primarily involving older adults in their mid-50s to late 70s. While MultiLoc nails offer shorter operation times and potentially reduced blood loss, both techniques effectively maintain the Neck Shaft Angle, a crucial factor for shoulder function. Comparable Constant-Murley scores and complication rates were observed between the two methods. PHILOS plates showed higher American Shoulder and Elbow Surgeons Shoulder Score (ASES) scores for two-part proximal humeral fractures with displacement. Other observations suggested advantages of MultiLoc nails in terms of faster union and fewer complications.