Functional outcome of proximal humerus fracture treated with proximal humerus interlocking system plating


  • Hemeshwar Harshwardhan Department of Orthopaedics, J.L.N. Medical College, Ajmer, Rajasthan, India
  • Buddhi Prakash Verma Department of Orthopaedics, J.L.N. Medical College, Ajmer, Rajasthan, India



Proximal humerus fracture, Proximal humerus interlocking system, Neer’s score


Background: Proximal humerus fractures account for 4-5% of all fractures. They are the commonest fractures in elderly population, which ranks the third, after hip and distal radius fractures respectively. Displaced fractures treated by pinning, cancellous screws, intra-medullary nails, proximal humeral plates and hemiarthroplasty. The proximal humerus interlocking system (PHILOS) plate is anatomically contoured and the threaded screw heads are locked into the threaded plate holes which allow early rehabilitation. The aim of this study is to evaluate results and complication of PHILOS.

Methods: This a prospective study, conducted at JLN Medical College, Ajmer from 1st January 2017 to 31st July 2018. 36 patients of displaced proximal humerus fractures were included and operated at hospital with PHILOS plating. We evaluate Intra-operative events, post-operative radiological evaluations and bony union by NEER’S score and complications.

Results: Functional results according to NEER’S score were found that out of 36 patients, 11 patients (30.5%) had excellent outcome, 19 patients (52.7%) have satisfactory outcome, 3 patients (8.33%) had unsatisfactory outcome and 3 patients (8.33%) had poor outcome.

Conclusions: Internal fixation of proximal humerus fractures with use of PHILOS yields reliable results when utilized correctly. To achieve gold standard results, early physiotherapy is must which can only be done by stable fixation, ORIF with PHILOS provides more stable construct with anatomical reduction.


Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-71.

Neer CS, Rockwood CA. Fractures and dislocations of the shoulder, In: Rockwood CA, Green DP (eds). Fracture in adults. Philadelphia, PA: Lippincott; 1984: 675-721.

Calvo E, Morcillo D, Foruria AM, Redondo-Santamaría E, Osorio-Picorne F, Caeiro JR, et al. Nondisplaced proximal humerusfractures: high incidence among outpatient treated osteoporotic fractures and severe impact on upper extremity function and patient subjective health perception. J Shoulder Elbow Surg. 2011;20(5);795-801.

Resch H, Povacz P, Frohlich R, Wambacher M. Percutaneous fixation of three- and four- part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79(2):295-300.

Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res. 2005;430:176-81.

Storhm PC, Helwig P, Konrad G, Sudkamp NP. Locking plate in proximal humerus fractures. Acta chirurgiaeorthopaedicae et traumatogiae. 2007;74:410-5.

Neer CS. Displaced proximal humeral fractures-II. Treatment of three part and four part displacement. J Bone Joint Surg Am. 1970;52(6):1090-103.

Canale ST, Beaty JH. Surgical techniques and approaches. Campbell's Operative Orthopedics. 12th edition. Mobsy: Elsevier; 2012: 100-106.

Stanley-Hoppenfield, Piet-deboer, Richard-buckley. The Shoulder. Surgical exposures in orthopedics: The anatomic approach 5th edition. Lippincott: Wolterskluwer; 2016.

Warriner AH, Patkar NM, Curtis JR, Delzell E, Gary L, Kilgore M, et al. Which fractures are most attributable to osteoporosis? J Clin Epidemiol. 2011;64:46-53.

Young TB, Wallace WA. Conservative treatment of fractures and fracture-dislocations of the upper end of humerus. J Bone Joint Surg Br. 1985;67(3):373-7.

Fazal MA, Haddad FS. PHILOS plate fixation for displaced proximal humeral fractures. J Orthop Surg. 2009;17(1):15-8.

Aggarwal S, Bali K, Dhillon MS, Kumar V, Mootha AK. Displaced proximal humeral fractures: An indian experience with locking plates. J Orthop Surg Res. 2010;5:60

Ong CC, Kwon YW, Walsh M, Davidovitch R, Zuckerman JD, Egol KA. Outcomes of open reduction and internal fixation of proximal humerus fractures managed with locking plates. Am J Orthop (Belle Mead NJ). 2012;41(9):407-12.

Chowdary U, Prasad H, Subramanyam PK. Outcome of locking compression plating for proximal humeral fractures: a prospective study. J Orthop Surg. 2014;22(1):4-8.

El-Sayed MMH. Surgical management of complex humerus head fractures. Orthop Rev (Pavia). 2010;2(2):14.






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