A study of proximal humerus fractures treated by PHILOS plating in a tertiary care hospital

S. Srikanth, A. Varun Kumar Reddy, Gudapati Omkarnath


Background: Proximal humeral fractures are commonly presented in the orthopedic practice. The usual method of treatment was conservative in the past. However, the results and functional outcomes were not good. With the development of PHILOS locking plates, the functional outcomes are known to be improved. We in the present study tried to evaluate the functional outcomes of proximal humerus fractures treated with PHILOS plates.

Methods: This prospective study was conducted in all Adult patients with closed two-part and three-part fractures of the proximal humerus, those who have reported within a week of the injury were included in the study. A total of n=30 patients were included in the study based on the inclusion and exclusion criteria. A standard surgical approach with PHILOS plate was used and patients were followed up for 19 to 24 months.

Results: n=30 patients out of which n=16 (53.33%) were males and n=14 (46.67%) were females. The most common age group involved in the fractures was 31-35 years n=9 (30%) of the patients. Most of the patients n=21 (70%) were having Neer's two-part fractures and three-part fractures were found in n=6 (20%) and four part in n=3 (10%). The overall results in the study were 66.67% of patients had excellent results and 16.67% had good results and 10% had poor results.

Conclusions: PHILOS locking plates is a better treatment option for fractures of proximal humerus especially in cases of poor bone quality and comminuted fractures.


Proximal humerus fractures, PHILOS plating, Functional outcome

Full Text:



Neer CS II, Rockwood CA. Fractures and dislocations of the shoulder, in Rockwood and Green: Fractures in adults, Philadelphia, PA: Lippincott; 1984: 675-621.

Zyto K. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury. 1998;29:349-52.

Lind T, Kroser K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Ortho Trauma Surg. 1989;108:285-87.

Iannotti JP, Ramsey ML, Williams GR Jr, Warner JJ. Nonprosthetic management of proximal humeral fractures. Instr Course Lect. 2004;53:403-16.

Ko JY, Yamamoto R. Surgical treatment of complex fracture of the proximal humerus. Clin Orthop Relat Res. 1996;327:225-37.

Kilic B, Uysal M, Cinar BM, Ozkoc G, Demirors H Akpinar S. Early results of treatment of proximal humerus fractures with the PHILOS locking plate. Acta Orthop Traumatol Turc. 2008;42(3):149-53.

Codman EA. Fractures in relation to the subacromial bursa. In: Codman EA (editor), The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa. Boston MA: Thomas Todd; 1934: 313-333.

Broos PL, Semon A. From unstable internal fixation to biological osteosynthesis. A historical overview of operative fracture treatment. Acta Chir Belg. 2004;104(4):396-400.

Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: Tips and tricks. J Bone Joint Surg Am. 2007;89(10):2298-07.

Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg 2010;19:489-94.

Lungershausen W, Bach O, Lorenz CO. Locking plate osteosynthesis for fractures of the proximal humerus. Zentralbl Chir. 2003;1289(1):28-33.

Shahid R, Mushtaq A, Northover J, Maqsood M. Outcome of proximal humerus fractures treated by PHILOS plate internal fixation. Experience of a District General Hospital. Acta Orthop Belg. 2008;74(5):602-8.

Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate. A retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75(6):741-45.

Rose PS, Adams CR, Torchia ME. Locking plate fixation for proximal humeral fractures: initial results with a new implant. J Shoulder Elbow Surg. 2007;16:202-07.

Siwach RC, Singh R, Rohila RK, Kadian VS, Sangwan SS, Dhanda M. Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis. J Orthop Traumatol. 2008;9:149-54.

Koukakis A, Apostolou C, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the PHILOS plate. Clin Orthop. 2006;442:115-20.

Wanner GA, Schmid EW, Romero J, Hersche O, von Smekal A, Trentz O, et al. Internal fixation of displaced proximal humeral fractures with two one-third tubular plates. J Trauma. 2003;54:536-44.

Sharma V, Singh B, Khare S. Management of Proximal Humeral Fractures with Proximal Humerus Locking Plated A Prospective Study. J Orthop Trauma Rehab. 2014;18:89-93.

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

Ebraheim NA, Vishwas P, Adeel H. Mini-external fixation of two- and three- part proximal humerus fractures. Acta Orthop Belg. 2007;73:437-42.

Klitscher D, Blum J, Andreas D, et al. Osteosynthesis of proximal humeral fractures with the fixed angle PHILOS-plate. Eur J Trauma Emerg Surg. 2008;34:29-36.

Hirschmann MT, Fallegger B, Amsler F, Regazzoni P, Gross T. Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS). J Orthop Trauma. 2011;25(5):286–93.

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

Acklin YP, Jenni R, Walliser M, Sommer C. Minimal invasive PHILOS-plate osteosynthesis in proximal humeral fractures. Eur J Trauma Emerg Surg. 2009;35:35-9.