Radiological correlation with functional outcome in displaced proximal humerus fractures treated with locking plates: a prospective study of 35 cases

Neetin Pralhad Mahajan, Nikhil Dilip Palange, Eknath D. Pawar, Hitesh Jivrajbhai Mangukiya, Ujwal Suryabhan Ramteke, Vedashish Ravesh, Umesh Jadhav, Prasannakumar G. S.


Background: The objective of this prospective study is to investigate the relationship between the functional outcome and the radiographic results of two-, three- and four part proximal humeral fractures treated with open reduction and fixation with PHILOS locking plate.

Methods: 35 patients (30 males and 5 females) with displaced proximal humerus fracture were treated with PHILOS plating and studied prospectively. According to Neer’s classification there were 16 two part fracture (45%), 15 three part fracture (42%) and 4 four part fracture (13%). The healing of fracture, head shaft angle (HSA) and complications were evaluated radiologically with plain radiographs whereas the functional outcome was assessed by the Shoulder Pain and Disability Index (SPADI) at 6 weeks, 3 months, 6 months and 1 year after surgery.

Results: In our study, patients treated with locking plates had mean forward flexion of 123°, abduction of 124°, mean external rotation of 30° and internal rotation 53° at 1 year follow-up. Maximum improvement in range of movement occurred between interval of 12 weeks to 24 weeks due to complete fracture union occurred approximately up to 12 weeks. The mean SPADI score at end of 1 year were 10.22, 10.38 and 10.20 for two, three and four part fractures respectively. Average postoperative and follow-up HSA's were 134.1±4.4 and 132.5±1.2 degrees, respectively. Varus progression was more prominent in patients with postoperative HSA <130 (p<0.001). Complications included impingement in 1 case, joint penetration by screw in 1 case, failure of fixation in 1 case and infection in 1 case.

Conclusions: Fixed angle locked plate is an extremely useful implant for reconstruction and salvage of proximal humeral fractures. Precise surgical technique, stable fracture fixation and restoration of anatomical reduction are absolutely necessary for improved outcome.


Displaced, Proximal humerus, Clinical, Radiological, Correlation

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Muthuuri JM. Outcome Of Plate Osteosynthesis In The Management Of Proximal Humeral Fractures In Adults. 8th ed. US: CBSPD; 2008.

Karataglis D, Stavridis SI, Petsatodis G. New trends in fixation of proximal humeral fractures: a review. Injury. 2011;42(4):330-8.

Gradl G, Knobe M, Pape HC. Decision making in displaced fractures of the proximal humerus: fracture or surgeon based? Int Orthop. 2015;39(2):329-34.

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

Siffri PC, Peindl RD, Coley ER, Norton J, Connor PM, Kellam JF. Biomechanical Analysis of Blade Plate Versus Locking Plate Fixation for a Proximal Humerus Fracture: Comparison Using Cadaveric and Synthetic Humeri. J Orthop Trauma. 2006;20:547–54.

Gardner MJ, Griffith MH, Dines JS. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. Clin Orthop Relat Res. 2005;434:123-9.

Rouch KE, Budiman-Muk E, Songsiridej N, Lertratanakul Y. Development of a Shoulder Pain and Disability Index Arthritis Care Res. 1991;4:143–9.

Hertel R, Knothe U, Ballmer FT. Geometry of the proximal humerus and implications for prosthetic design. J Shoulder Elbow Surg. 2002;11(4):331-8.

Singer BR, McLauchlan GJ, Robinson CM, Christi J. Epidemiology of fractures in 15 000 adults The influence of age and gender. J Bone Joint Surg [Br]. 1998;80:243.

Südkamp N, Bayer J, Hepp P. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009;91(6):1320-8.

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.

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.

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.

Bigorre N, Talha A, Cronier P, Hubert L, Toulemonde JL, Massin P. A prospective study of a new locking plate for proximal humeral fracture. Injury. 2009;40(2):192-6.

Geiger EV. Functional outcome and complications following proximal humerus interlocking system plate fixation in proximal humerus fracture. Acta orthopaedic traumatol turc. 2010;44(1):1-6.

Spross C, Platz A, Rufibach K, Lattmann T, Forberger J, Dietrich M. The PHILOS plate for proximal humeral fractures--risk factors for complications at one year. J Trauma Acute Care Surg. 2012;72(3):783-9.

Ong CC, Kwon YW, Walsh M, Davidovitch R, Zuckermann JD, Egol KA. Outcomes of Open Reduction and Internal Fixation of Proximal Humerus Fractures Managed With Locking Plates. Am J Orthop. 2012;41(9):407-12.

Antuña SA, Sperling JW, Cofield RH. Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg. 2008;17(2):202-9.

Dietrich M, Meier C, Lattmann T, Zingg U, Grüninger P, Platz A. Complex fracture of the proximal humerus in the elderly. Locking plate osteosynthesis vs hemiarthroplasty. Chirurg. 2008;79(3):231-40.

Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009;91(7):1689-97.

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.

Use of angle-stable implants for proximal humeral fractures: prospective study. J Bone Joint Surg Br. 2004;86(6):848-55.

Wijgman AJ, Roolker W, Patt TW. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84(11):1919-25.

Esser RD. Open reduction and internal fixation of three- and four-part fractures of the proximal humerus. Clin Orthop Relat Res. 1994;(299):244-51.

Paavolainen P, Björkenheim JM, Slätis P, Paukku P. Operative treatment of severe proximal humeral fractures. Acta Orthop Scand. 1983;54(3):374-9.

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.

Ugur Gonç, Mesut Atabek, Kürs¸ at Teker, Altug Tanrıover. Minimally invasive plate osteosynthesis with PHILOS plate for proximal humerus fractures. Acta Orthopaedica et Traumatologica Turcica. 2017;51:17-22.