Locking plate for displaced proximal humerus fractures-outcomes and complications: a prospective study


  • Avinash Rathod Department of Orthopaedics, JIPMER, Pondicherry, India
  • Gopisankar Balaji Department of Orthopaedics, JIPMER, Pondicherry, India
  • Dilip Patro Department of Orthopaedics, JIPMER, Pondicherry, India




Humerus, Treatment outcome, Fracture fixation


Background: The management of unstable proximal humerus fractures is controversial as many fixation techniques have evolved over the years claiming to be a better fixation device compared to the other.

Methods: 23 patients with closed displaced proximal humerus fractures were included in this study. All patients underwent open reduction and internal fixation with proximal humerus locking plate through either delto-pectoral or deltoid splitting approach. Standard shoulder rehabilitation program was used in all cases. Functional and radiological outcome were assessed at follow-up.

Results: The mean constant-Murley score achieved at 6 months was 66. Complications were reported in a total of 7 patients including 3 varus malunion, 1 valgus malunion, 2 screw penetration into the joint and 1 nonunion with implant breakage.

Conclusions: The proximal humeral locking plate seems to be an adequate device for the fixation of displaced proximal humerus fractures as 83% of our study population had good/moderate functional outcomes.



Kristiansen B, Barfod G, Bredesen J, Erin-Madsen J, Grum B, Horsnaes MW, et al. Epidemiology of proximal humeral fractures. Acta Orthop Scand. 1987;58(1):75–7.

Burkhart KJ, Dietz SO, Bastian L, Thelen U, Hoffmann R, Müller LP. The treatment of proximal humeral fracture in adults. Dtsch Arzteblatt Int. 2013;110(35–36):591–7.

Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg. 2009 ;18(6):837–44.

Neer CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52(6):1077–89.

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop. 1987;(214):160–4.

Moeller AD, Thorsen RR, Torabi TP, Bjoerkman A-SD, Christensen EH, Maribo T, et al. The Danish version of the modified Constant-Murley shoulder score: reliability, agreement, and construct validity. J Orthop Sports Phys Ther. 2014;44(5):336–40.

Vijayvargiya M, Pathak A, Gaur S. Outcome Analysis of Locking Plate Fixation in Proximal Humerus Fracture. J Clin Diagn Res JCDR. 2016;10(8):RC01-05.

Yang H, Li Z, Zhou F, Wang D, Zhong B. A prospective clinical study of proximal humerus fractures treated with a locking proximal humerus plate. J Orthop Trauma. 2011 ;25(1):11–7.

Sakai T, Sugano N, Nishii T, Hananouchi T, Yoshikawa H. Extent of osteonecrosis on MRI predicts humeral head collapse. Clin Orthop. 2008;466(5):1074–80.

Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006 ;37(8):691–7.

Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C, et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res OTSR. 2012;98(6):715–9.

Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus: A retrospective analysis of 82 cases treated with the Philos(®) locking plate. Injury. 2014;45 Suppl 6:S43-48.

Menendez ME, Ring D. Does the timing of surgery for proximal humeral fracture affect inpatient outcomes? J Shoulder Elbow Surg. 2014;23(9):1257–62.

Buecking B, Mohr J, Bockmann B, Zettl R, Ruchholtz S. Deltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures? Clin Orthop. 2014 ;472(5):1576–85.

Waliullah S, Kumar A. Difference between radiological and functional outcome with deltoid-splitting approach versus deltopectoral approach for the management of proximal humeral fractures with philos plate. J Orthop Allied Sci. 2013;1(1):14.

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

Repetto I, Alessio-Mazzola M, Cerruti P, Sanguineti F, Formica M, Felli L. Surgical management of complex proximal humeral fractures: pinning, locked plate and arthroplasty : Clinical results and functional outcome on retrospective series of patients. Musculoskelet Surg. 2017;24:1-6.

Kumar GNK, Sharma G, Sharma V, Jain V, Farooque K, Morey V. Surgical treatment of proximal humerus fractures using PHILOS plate. Chin J Traumatol Zhonghua Chuang Shang Za Zhi. 2014;17(5):279–84.

Martetschläger F, Siebenlist S, Weier M, Sandmann G, Ahrens P, Braun K, et al. Plating of proximal humeral fractures. Orthopedics. 2012;35(11):e1606-1612.

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.

Aksu N, Göğüş A, Kara AN, Işiklar ZU. Complications encountered in proximal humerus fractures treated with locking plate fixation. Acta Orthop Traumatol Turc. 2010;44(2):89–96.

Geiger EV, Maier M, Kelm A, Wutzler S, Seebach C, Marzi I. Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthop Traumatol Turc. 2010;44(1):1–6.

Thyagarajan DS, Haridas SJ, Jones D, Dent C, Evans R, Williams R. Functional outcome following proximal humeral interlocking system plating for displaced proximal humeral fractures. Int J Shoulder Surg. 2009;3(3):57–62.

Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009;23(3):163–72.

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

Kiliç B, Uysal M, Cinar BM, Ozkoç G, Demirörs 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.

Handschin AE, Cardell M, Contaldo C, Trentz O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury. 2008 ;39(3):306–13.

Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. [Treatment of proximal humeral fractures with the PHILOS angular stable plate. Presentation of 225 cases of dislocated fractures]. Unfallchirurg. 2006;109(12):1032–40.

Björkenheim J-M, 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):741–5.






Original Research Articles