Analysis of surgical fixation of displaced proximal humerus fractures using PHILOS plate

Lalith Mohan Chodavarapu, Sreekanth Kashayi Chowdojirao, Avinash Gonu, Chandrasekhar Patnala, Vijay Krishna Chilakamarri


Background: The treatment of displaced proximal humeral injuries still throws challenges in identifying variables to prognosticate the outcome and optimizing a good clinical result. This study attempts to analyze the functional outcome of surgery of such fractures with proximal humeral interlocking system (PHILOS) plate and evaluate variables which help in predicting the prognosis.

Methods: This is a retrospective and prospective study of 30 patients with displaced proximal humerus fractures - 2 part, 3 part, 4 part and fracture dislocations according to Neer classification, surgically treated using PHILOS plate during 2011 and 2014. Evaluation of patients was done on follow-up by an independent observer for union by radiographs and functional assessment by Constant-Murley score and DASH (disabilities of the arm, shoulder and hand) score.

Results: The mean age of the patients was 40.4 years (range 18-65). 83.3% of the patients were male. The mean follow-up was 18.9 months (4-36 months). The mean Constant-Murley score and the DASH score were 76 and 16 respectively at the last follow-up. Our analysis showed that the patient’s age, delay in surgery, and Neer’s classification influenced the prognosis of the fracture. Medial metaphyseal extension in the fracture or an intact medial neck showed a better outcome. Complications were seen in 5 patients. Avascular necrosis was seen in 3 patients.

Conclusions: Osteosynthesis of displaced proximal humeral fractures with PHILOS plate provides a good outcome, with low complication rate. Patient’s age and the type of fracture based on Neer’s classification prognosticate the outcome. 


Proximal humerus fractures, PHILOS plate

Full Text:



Bengner U, Johnell O, Redlund-Johnell I. Changes in the incidence of fracture of the upper end of humerus, during a 30 year period: A study of 2125 fractures. Clin Orthop Relat Res. 1988;(231):179-82.

Hawkins RJ, Bell RH, Gurr K. The three part fracture of the proximal part of the humerus. Operative treatment. J Bone Joint Surg Am. 1986;68(9):1410-4.

Sproul RC, Iyengar JJ, Devic Z, Feely BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011;42(4):408-13.

Papadopoulos P, Karataglis D, Stavridis SI, Petsatodis G, Christodoulou A. Mid-term results of internal fixation of proximal humeral fractures with the Philos plate. Injury. 2009;40(12):1292-6.

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.

Martinez AA, Cuenca J, Herrera A. Philos plate fixation for proximal humeral fractures. J Orthop Surg (Hong Kong). 2009;17(1):10-4.

Fazal MA, Haddad FS. Philos plate fixation for displaced proximal humeral fractures. J Orthop Surg (Hong Kong). 2009;17(1):15-89.

Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg Br. 2007;89(9):1206-9.

Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M. Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg. 2007;127(3):205-10.

Lee CW, Shin SJ. Prognostic factors for unstable proximal humeralfractures treated with locking-plate fixation. J Shoulder Elbow Surg. 2009;18(1):83-8.

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

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-4.

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602-8.

Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011:42(11):1283-8.

Sinha S, Kelly CP. Fixed angle locking plates for proximal humerus fracture fixation. Ann R Coll Surg Engl. 2010;92(8):631-4.

Solberg BD, Moon CN, Franco DP, Paiement GD. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. Orthop Trauma. 2009;23:113-9.

Hertel R, Hempfing A, Steihler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of proximal humerus. J Shoulder Elbow Surg. 2004;13(4):427-33.

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

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.

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;45:43-8.

Bandalović A, Cukelj F, Knežević J, Ostojić M, Pavić A, Parać Z. The Results of Internal Fixation of Proximal Humeral Osteoporotic Fractures with PHILOS Locking Plate. Psychiatr Danub. 2014;26(2):376-81.

Kumar GN, Sharma G, Sharma V, Jain V, Farooque K, Morey V. Surgical treatment of proximal humerus fractures using PHILOS plate. Chin J Traumatol. 2014;17(5):279-84.

Robinson CM, Page RS. Severely impacted valgus proximal humerus fractures. J Bone Joint Surg Am. 2004;86(1):143-55.

Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg. 2002;84:1919–25.

Hessmann M, Baumgaertel F, Gelling H. Plate fixation of proximal humerus fractures with indirect reduction: Surgical techniques and results utilising three shoulder score. Injury. 1999;30:453-62.

Wanner CA, Romero I, Hersche O, Smekal A, Ertel W. Dislocated proximal humerus fracture - results after stabilization with a double plate. Langenbecks Arch Chir Suppl Kongressbd. 1998;115:1211-2.

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.