Early results of treatment of proximal humerus fractures with the PHILOS locking plate

Objectives: The aim of this study was to evaluate early results of proximal humerus fractures treated with the PHILOS locking plate. Methods: Proximal humerus fractures of 22 patients (13 males, 9 females; mean age 57 years; range 35 to 83 years) were treated with the PHILOS locking plate. According to the Neer classification, 13 patients had comminuted frac¬tures, four patients had valgus impact injuries, two patients had fracture-dislocations, and three patients had fractures involving the proximal 1/3 of the humerus. The fractures were reduced by the transdeltoid lateral approach (n=8) us¬ing minimally invasive surgery, and by the anterior delto- pectoral approach (n=14) using open surgery. Passive and active exercises were initiated on the second postoperative day and after 4 to 6 weeks, respectively. The results were as¬sessed using the Constant-Murley shoulder scoring system. The mean follow up was 14 months (range 12 to 19 months). Results: Radiographically, union was observed in 20 pa¬tients at the end of 10 weeks. In one patient, time to union was 16 weeks. One patient underwent autogenous bone grafting because of nonunion after 16 weeks. The mean Constant-Murley score was 75.5 (range 51 to 93). There was no significant difference between Constant-Murley scores of patients undergoing the transdeltoid lateral and anterior deltopectoral approaches (p>0.05). Plate fixation was asso¬ciated with minimal varus deformity in two patients, and subacromial impingement in one patient. Implant failure did not occur. Reflex sympathetic dystrophy and avascular ne¬crosis were observed in two patients, respectively. Conclusion: Fixation with the PHILOS plate is a near- ideal technique with a high union rate in the treatment of proximal humeral fractures.