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Proximal Humerus Internal Locking System (PHILOS) Plating Versus External Fixation Using Kirschner Wires (K-Wires)
Pavneesh Kumar1, Indrajit D Bhoumik1, Pearly Swedia1
1Department of Orthopedics, Government Doon Medical College, Dehradun, IND.
Cureus
|August 13, 2026
Summary
Proximal humerus fractures treated with PHILOS plates showed better functional outcomes and shoulder range of motion compared to K-wires and frames. Both methods achieved satisfactory union, but PHILOS plating offers advantages for selected patients.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Biomedical Engineering
Background:
- Proximal humerus fractures are common shoulder injuries requiring surgical intervention for displaced or unstable cases.
- Internal fixation with PHILOS plates and external fixation with K-wires/frames are common surgical options.
- Limited comparative data exists on clinical outcomes, especially in the Indian population.
Purpose of the Study:
- To compare the clinical and functional outcomes of PHILOS plating versus external fixation for proximal humerus fractures.
- To evaluate functional recovery using QuickDASH scores and range of motion.
- To assess complications and time to union in both treatment groups.
Main Methods:
- A prospective comparative observational study included 60 adult patients with proximal humerus fractures.
- 30 patients underwent PHILOS plating, and 30 received external fixation (K-wires and frames).
- Functional outcomes (QuickDASH), range of motion, operative details, and complications were assessed postoperatively.
Main Results:
- Both PHILOS plating and external fixation showed comparable radiological union rates (90.0% vs. 83.3%).
- PHILOS plating resulted in significantly lower QuickDASH scores at 3 and 6 months, indicating better function.
- Greater shoulder forward flexion and abduction were observed in the PHILOS group at 6 months, with similar complication rates (26.7%).
Conclusions:
- PHILOS plating and external fixation provide satisfactory union and functional recovery for proximal humerus fractures.
- PHILOS plating demonstrated superior functional outcomes and range of motion compared to external fixation.
- PHILOS plating may be preferred for selected proximal humerus fractures due to better functional results despite longer operative time and hospitalization.
