Functional and Radiological Outcomes of Displaced Proximal Humerus Fractures Treated With the Proximal Humerus...

Background Angular-stable fixation with the proximal humerus internal locking system (PHILOS) is widely used for displaced proximal humerus fractures. We prospectively evaluated its functional and radiological outcomes over 24 weeks at a tertiary-care center. Methodology Forty-three adults with proximal humerus fractures considered to require operative fixation underwent open reduction and internal fixation with a PHILOS plate. Pain (visual analog scale, VAS) and shoulder function (Constant-Murley score, CMS) were assessed at two, six, 12, and 24 weeks; time to union and immediate post-operative neck-shaft angle (NSA) and humeral head height were recorded. Serial change was analyzed with the Friedman test and, as confirmation, Greenhouse-Geisser-corrected repeated-measures analysis of variance (ANOVA), with Bonferroni-adjusted Wilcoxon post-hoc comparisons. Results Mean age was 48.0 ± 14.4 years (32 men, 11 women); all 43 patients completed follow-up. Mean total CMS rose from 40.7 ± 1.7 at 2 weeks to 54.3 ± 2.6, 66.6 ± 3.3 and 76.1 ± 3.6 at 6, 12 and 24 weeks (Friedman χ² = 129.0, p < 0.001; repeated-measures ANOVA p < 0.001). Mean VAS fell from 9.1 ± 0.6 pre-operatively to 1.2 ± 0.4 at 24 weeks (p < 0.001); all pairwise interval comparisons were significant (p < 0.001). At 24 weeks, 18.6% of shoulders were graded excellent, 79.1% good, and 2.3% fair. All fractures united (mean 9.8 ± 2.6 weeks). Final CMS was lower with higher Neer grade (p = 0.007) and increasing age (ρ = -0.35, p = 0.02). Immediate post-operative NSA (133 ± 3°) and head height (8.7 ± 1.3 mm) were within accepted limits. Conclusions PHILOS fixation produced progressive, statistically significant improvements in pain and shoulder function, with a 100% union rate over 24 weeks; outcomes were poorer in older patients and in patients with more complex fractures. The single-center design, the absence of a comparison group, and the mid-term follow-up limit generalisability, and longer follow-up is needed to capture late complications such as avascular necrosis.