Functional Outcome of Displaced Proximal Humerus Fractures Managed by Proximal Humerus Interlocking System Plate
-
Atharva Sharma
,
Bibhas DasGupta
,
Mihir Patel
,
Mahesh B. Shinde
,
Sanket Jethliya
,
Shreyas Revankar
,
Deepanshu Garg
,
Rohan Bahl
,
Patil Yogeshwari
,
Siddharth Mitra
,
Samreen Chunawala
,
Yash Nav Singh
,
Singh Akanksha
Abstract
Background: Proximal humerus fractures are common, especially in the elderly, and often result from low-energy falls or high energy trauma in younger patients. These fractures pose a management challenge due to varied patterns and complex anatomy. While many are treated conservatively, displaced or comminuted fractures often require surgical fixation. Locking plates, particularly the proximal humeral internal locking system (PHILOS), offer stable fixation and improved outcomes, especially in osteoporotic bone. This study aims to assess the functional outcome of displaced proximal humerus fractures treated with PHILOS plating at a tertiary care teaching hospital in Mumbai, India.
Methods: This prospective observational study involved 30 adults with displaced proximal humerus fractures treated with PHILOS plating. After informed consent, patients underwent surgery and standardized postoperative rehabilitation. Shoulder function was assessed using the Constant-Murley score (CMS) at 6 weeks, 3 months, and 6 months. Data were analyzed using t-tests and chi-square tests. Results were expressed as mean ± standard deviation (SD) and percentages, with significance set at P < 0.05.
Results: This study included 30 patients (mean age: 52.5 years); 70% were men. Most injuries were due to road traffic accidents (RTAs) (70%), with two-part fractures being most common (60%). Radiological union occurred at 6-8 weeks in 80%, 9-12 weeks in 16.7%, and after 12 weeks in 3.3% of patients. The CMS improved significantly over 6 months (P < 0.0001). Functional outcomes were good to fair in most patients. Postoperative complications occurred in 36.67%, mainly shoulder stiffness (23.33%), followed by impingement (10%) and malreduction (3.33%).
Conclusion: The PHILOS plate offers stable fixation and favorable functional outcomes in proximal humerus fractures, with timely union and improved CMS, making it an effective option despite minor complications.
1. Alzobi OZ, Salman LA, Derbas J, Abudalou A, Hantouly AT, Ahmed G. Epidemiology of proximal humerus fractures in Qatar. Eur J Orthop Surg Traumatol. 2023;33(7):3119-24. doi: 10.1007/s00590-023-03539-5. [PubMed: 37038016]. [PubMed Central: PMC10504139].
2. Kantharaju H, Gawhale SK, Prasanna Kumar GS, Sahare B, Shah N. Factors Influencing the Varus Deformity of Humeral Head in Proximal Humerus Fractures and Its Relation to Functional Outcome. Indian J Orthop. 2021;55(3):702-7. doi: 10.1007/s43465-020-00275-4. [PubMed Central: 33995876]. [PubMed: PMC8081816].
3. Edwards S, Israel HA, Cannada L, Anderson PA. Yes We Can! Reducing the Burden of Proximal Humerus Fractures. J Orthop Exp Innov. 2025;6(1). doi: 10.60118/001c.129046.
4. Tsuda T. Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature. Curr Orthop Pract. 2017;28(6):580-5. doi: 10.1097/bco.0000000000000563. [PubMed: 29177024]. [PubMed Central: PMC5671779].
5. Chavhan S, Modak R, Madikattu S, Kansagara J, Swami A. A cross-sectional study of functional outcome of proximal humerus fractures treated with closed reduction and percutaneous pinning. Int J Orthop Sci. 2018;4(1):335-8. doi: 10.22271/ortho.2018.v4.i1e.50.
6. Hannonen J, Hyvönen H, Korhonen L, Serlo W, Sinikumpu JJ. The incidence and treatment trends of pediatric proximal humerus fractures. BMC Musculoskelet Disord. 2019;20(1):571. doi: 10.1186/s12891-019-2948-7. [PubMed: 31775692]. [PubMed Central: PMC6882178].
7. Koeppe J, Stolberg-Stolberg J, Fischhuber K, Iking J, Marschall U, Raschke MJ, et al. The Incidence of Proximal Humerus Fracture-an Analysis of Insurance Data. Dtsch Arztebl Int. 2023;120(33-34):555-6. doi: 10.3238/arztebl.m2023.0132. [PubMed: 37732593]. [PubMed Central: PMC10546881].
8. Baker HP, Gutbrod J, Cahill M, Shi L. Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges. Orthop Res Rev. 2023;15:129-37. doi: 10.2147/orr.S340536. [PubMed: 37396822]. [PubMed Central: PMC10312335].
9. Vachtsevanos L, Hayden L, Desai AS, Dramis A. Management of proximal humerus fractures in adults. World J Orthop. 2014;5(5):685-93. doi: 10.5312/wjo.v5.i5.685. 25405098]. [PubMed Central: PMC4133477].
10. Khmelnitskaya E, Lamont LE, Taylor SA, Lorich DG, Dines DM, Dines JS. Evaluation and management of proximal humerus fractures. Adv Orthop. 2012;2012:861598. doi: 10.1155/2012/861598. [PubMed: 23316376]. [PubMed Central: PMC3535990].
11. Pencle F, Varacallo MA. Proximal Humerus Fracture. Treasure Island, FL: StatPearls Publishing; 2025.
12. Younis Z, Hamid MA, Amin J, Khan MM, Gurukiran G, Sapra R, et al. Proximal Humerus Fractures: A Review of Anatomy, Classification, Management Strategies, and Complications. Cureus. 2024;16(11):e73075. doi: 10.7759/cureus.73075. [PubMed: 39640099]. [PubMed Central: PMC11620479].
13. Martinez-Catalan N. Conservative Treatment of Proximal Humerus Fractures: When, How, and What to Expect. Curr Rev Musculoskelet Med. 2023;16(2):75-84. doi: 10.1007/s12178-022 09817-9. [PubMed: 36562923]. [PubMed Central: PMC9889589]. 14. Widnall JC, Dheerendra SK, Malal JJ, Waseem M. Proximal humeral fractures: A review of current concepts. Open Orthop J. 2013;7:361-5. doi: 10.2174/1874325001307010361. [PubMed: 24082976]. [PubMed Central: PMC3785034].
15. Pandey R, Raval P, Manibanakar N, Nanjayan S, McDonald C, Singh H. Proximal humerus fracture(s): A review of current practice. J Clin Orthop Trauma. 2023;43:102233. doi: 10.1016/j.jcot.2023.102233. [PubMed: 37636006]. [PubMed Central: PMC10457443].
16. Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2022;6(6):Cd000434. doi: 10.1002/14651858.CD000434.pub5. [PubMed Central: PMC9211385]. [PubMed: 35727196].
17. Barlow JD, Logli AL, Steinmann SP, Sems SA, Cross WW, Yuan BJ, et al. Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. J Shoulder Elbow Surg. 2020;29(8):1689-94. doi: 10.1016/j.jse.2019.11.026. [PubMed: 32088075].
18. Laux CJ, Grubhofer F, Werner CML, Simmen HP, Osterhoff G. Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res. 2017;12(1):137. doi: 10.1186/s13018-017-0639-3. [PubMed: 28946902]. [PubMed Central: PMC5613450].
19. Cohen M, Amaral MV, Monteiro M, Brandão BL, Motta Filho GR. Osteosynthesis of Proximal Humeral End Fractures With Fixed Angle Plate And Locking Screws: Technique And Results. Rev Bras Ortop. 2009;44(2):106-11. doi: 10.1016/s2255-4971(15)30056-2. [PubMed: 26998460]. [PubMed Central: PMC4783608].
20. Cheng H, Yu J, Dong Z, Lin H, Liu Q, Zhang X, et al. Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely - A Retrospective Study. Geriatr Orthop Surg Rehabil. 2021;12:21514593211050155. doi: 10.1177/21514593211050155. [PubMed: 34671509]. [PubMed Central: PMC8521760].
21. Gaheer RS, Hawkins A. Fixation of 3- and 4-part proximal humerus fractures using the PHILOS plate: mid-term results. Orthopedics. 2010;33(9):671. doi: 10.3928/01477447-20100722-11. [PubMed: 20839704].
22. Deepak CD, D. V M, Ravoof A, Baruah MJ. Functional outcome of displaced proximal humerus fractures managed by proximal humerus interlocking system plate. Int J Res Orthop. 2017;3(3):583-8. doi: 4510.IntJResOrthop20171906. 10.18203/issn.2455-23. Vijayvargiya M, Pathak A, Gaur S. Outcome Analysis of Locking Plate Fixation in Proximal Humerus Fracture. J Clin Diagn Res. 2016;10(8):Rc01-5. doi: 10.7860/jcdr/2016/18122.8281. [PubMed: 27656515]. [PubMed Central: PMC5028477]. 24. Sagar BG, Ansar M, S G. Functional outcome of proximal humerus fracture management with proximal humerus internal locking system plate. Int J Orthop Sci. 2021;7(2):736-9. doi: 10.22271/ortho.2021.v7.i2j.2696.
25. Rao NVN, Dr. Challa S. Study on functional outcome of the proximal humeral internal locking system (PHILOS) for displaced proximal humeral fractures in adults. Int J Surg Trauma Orthop. 2019;5(5):355-64. doi: 10.17511/ijoso.2019.i05.07.
26. 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. [PubMed: 19058692].
27. Leonard M, Mokotedi L, Alao U, Glynn A, Dolan M, Fleming P. The use of locking plates in proximal humeral fractures: Comparison of outcome by patient age and fracture pattern. Int J Shoulder Surg. 2009;3(4):85-9. doi: 10.4103/0973 6042.63214. [PubMed: PMC2878702]. 20532009]. [PubMed Central:
28. Siddalingamurthy G, Ravi Kiran HG, Abhilash Gowd B, Darshan CK, Mruthyunjaya. Functional outcome of proximal humeral interlocking system plating for displaced proximal humeral fractures in adults. Int J Orthop Sci. 2017;3(2):32-7. doi: 10.22271/ortho.2017.v3.i2a.09.
29. Patted P, Sadiq M. Functional outcome of proximal humeral interlocking system plating for displaced proximal humeral fractures: A prospective study. Nat J Clin Orthop. 2021;5(3): 167-9. doi: 10.33545/orthor.2021.v5.i3c.313.
30. Sathavu PP, Kothimbakkam PK, Murugan PB, Mohideen S, Murugesan V, Ranganathan T. Functional and Radiological Outcome of Proximal Humerus Fractures Treated with Proximal Humerus Internal Locking Osteosynthesis System Plating - A Prospective Study. J Orthop Case Rep. 2025;15(6): 294-9. doi: 10.13107/jocr.2025.v15.i06.5742. [PubMed: 40520751]. [PubMed Central: PMC12159620].
2. Kantharaju H, Gawhale SK, Prasanna Kumar GS, Sahare B, Shah N. Factors Influencing the Varus Deformity of Humeral Head in Proximal Humerus Fractures and Its Relation to Functional Outcome. Indian J Orthop. 2021;55(3):702-7. doi: 10.1007/s43465-020-00275-4. [PubMed Central: 33995876]. [PubMed: PMC8081816].
3. Edwards S, Israel HA, Cannada L, Anderson PA. Yes We Can! Reducing the Burden of Proximal Humerus Fractures. J Orthop Exp Innov. 2025;6(1). doi: 10.60118/001c.129046.
4. Tsuda T. Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature. Curr Orthop Pract. 2017;28(6):580-5. doi: 10.1097/bco.0000000000000563. [PubMed: 29177024]. [PubMed Central: PMC5671779].
5. Chavhan S, Modak R, Madikattu S, Kansagara J, Swami A. A cross-sectional study of functional outcome of proximal humerus fractures treated with closed reduction and percutaneous pinning. Int J Orthop Sci. 2018;4(1):335-8. doi: 10.22271/ortho.2018.v4.i1e.50.
6. Hannonen J, Hyvönen H, Korhonen L, Serlo W, Sinikumpu JJ. The incidence and treatment trends of pediatric proximal humerus fractures. BMC Musculoskelet Disord. 2019;20(1):571. doi: 10.1186/s12891-019-2948-7. [PubMed: 31775692]. [PubMed Central: PMC6882178].
7. Koeppe J, Stolberg-Stolberg J, Fischhuber K, Iking J, Marschall U, Raschke MJ, et al. The Incidence of Proximal Humerus Fracture-an Analysis of Insurance Data. Dtsch Arztebl Int. 2023;120(33-34):555-6. doi: 10.3238/arztebl.m2023.0132. [PubMed: 37732593]. [PubMed Central: PMC10546881].
8. Baker HP, Gutbrod J, Cahill M, Shi L. Optimal Treatment of Proximal Humeral Fractures in the Elderly: Risks and Management Challenges. Orthop Res Rev. 2023;15:129-37. doi: 10.2147/orr.S340536. [PubMed: 37396822]. [PubMed Central: PMC10312335].
9. Vachtsevanos L, Hayden L, Desai AS, Dramis A. Management of proximal humerus fractures in adults. World J Orthop. 2014;5(5):685-93. doi: 10.5312/wjo.v5.i5.685. 25405098]. [PubMed Central: PMC4133477].
10. Khmelnitskaya E, Lamont LE, Taylor SA, Lorich DG, Dines DM, Dines JS. Evaluation and management of proximal humerus fractures. Adv Orthop. 2012;2012:861598. doi: 10.1155/2012/861598. [PubMed: 23316376]. [PubMed Central: PMC3535990].
11. Pencle F, Varacallo MA. Proximal Humerus Fracture. Treasure Island, FL: StatPearls Publishing; 2025.
12. Younis Z, Hamid MA, Amin J, Khan MM, Gurukiran G, Sapra R, et al. Proximal Humerus Fractures: A Review of Anatomy, Classification, Management Strategies, and Complications. Cureus. 2024;16(11):e73075. doi: 10.7759/cureus.73075. [PubMed: 39640099]. [PubMed Central: PMC11620479].
13. Martinez-Catalan N. Conservative Treatment of Proximal Humerus Fractures: When, How, and What to Expect. Curr Rev Musculoskelet Med. 2023;16(2):75-84. doi: 10.1007/s12178-022 09817-9. [PubMed: 36562923]. [PubMed Central: PMC9889589]. 14. Widnall JC, Dheerendra SK, Malal JJ, Waseem M. Proximal humeral fractures: A review of current concepts. Open Orthop J. 2013;7:361-5. doi: 10.2174/1874325001307010361. [PubMed: 24082976]. [PubMed Central: PMC3785034].
15. Pandey R, Raval P, Manibanakar N, Nanjayan S, McDonald C, Singh H. Proximal humerus fracture(s): A review of current practice. J Clin Orthop Trauma. 2023;43:102233. doi: 10.1016/j.jcot.2023.102233. [PubMed: 37636006]. [PubMed Central: PMC10457443].
16. Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2022;6(6):Cd000434. doi: 10.1002/14651858.CD000434.pub5. [PubMed Central: PMC9211385]. [PubMed: 35727196].
17. Barlow JD, Logli AL, Steinmann SP, Sems SA, Cross WW, Yuan BJ, et al. Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. J Shoulder Elbow Surg. 2020;29(8):1689-94. doi: 10.1016/j.jse.2019.11.026. [PubMed: 32088075].
18. Laux CJ, Grubhofer F, Werner CML, Simmen HP, Osterhoff G. Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res. 2017;12(1):137. doi: 10.1186/s13018-017-0639-3. [PubMed: 28946902]. [PubMed Central: PMC5613450].
19. Cohen M, Amaral MV, Monteiro M, Brandão BL, Motta Filho GR. Osteosynthesis of Proximal Humeral End Fractures With Fixed Angle Plate And Locking Screws: Technique And Results. Rev Bras Ortop. 2009;44(2):106-11. doi: 10.1016/s2255-4971(15)30056-2. [PubMed: 26998460]. [PubMed Central: PMC4783608].
20. Cheng H, Yu J, Dong Z, Lin H, Liu Q, Zhang X, et al. Treatment of 2-Part Proximal Humeral Fractures in Osteoporotic Patients With Medial Calcar Instability Using a PHILOS Plate Plus an Allogeneic Fibula Inserted Obliquely - A Retrospective Study. Geriatr Orthop Surg Rehabil. 2021;12:21514593211050155. doi: 10.1177/21514593211050155. [PubMed: 34671509]. [PubMed Central: PMC8521760].
21. Gaheer RS, Hawkins A. Fixation of 3- and 4-part proximal humerus fractures using the PHILOS plate: mid-term results. Orthopedics. 2010;33(9):671. doi: 10.3928/01477447-20100722-11. [PubMed: 20839704].
22. Deepak CD, D. V M, Ravoof A, Baruah MJ. Functional outcome of displaced proximal humerus fractures managed by proximal humerus interlocking system plate. Int J Res Orthop. 2017;3(3):583-8. doi: 4510.IntJResOrthop20171906. 10.18203/issn.2455-23. Vijayvargiya M, Pathak A, Gaur S. Outcome Analysis of Locking Plate Fixation in Proximal Humerus Fracture. J Clin Diagn Res. 2016;10(8):Rc01-5. doi: 10.7860/jcdr/2016/18122.8281. [PubMed: 27656515]. [PubMed Central: PMC5028477]. 24. Sagar BG, Ansar M, S G. Functional outcome of proximal humerus fracture management with proximal humerus internal locking system plate. Int J Orthop Sci. 2021;7(2):736-9. doi: 10.22271/ortho.2021.v7.i2j.2696.
25. Rao NVN, Dr. Challa S. Study on functional outcome of the proximal humeral internal locking system (PHILOS) for displaced proximal humeral fractures in adults. Int J Surg Trauma Orthop. 2019;5(5):355-64. doi: 10.17511/ijoso.2019.i05.07.
26. 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. [PubMed: 19058692].
27. Leonard M, Mokotedi L, Alao U, Glynn A, Dolan M, Fleming P. The use of locking plates in proximal humeral fractures: Comparison of outcome by patient age and fracture pattern. Int J Shoulder Surg. 2009;3(4):85-9. doi: 10.4103/0973 6042.63214. [PubMed: PMC2878702]. 20532009]. [PubMed Central:
28. Siddalingamurthy G, Ravi Kiran HG, Abhilash Gowd B, Darshan CK, Mruthyunjaya. Functional outcome of proximal humeral interlocking system plating for displaced proximal humeral fractures in adults. Int J Orthop Sci. 2017;3(2):32-7. doi: 10.22271/ortho.2017.v3.i2a.09.
29. Patted P, Sadiq M. Functional outcome of proximal humeral interlocking system plating for displaced proximal humeral fractures: A prospective study. Nat J Clin Orthop. 2021;5(3): 167-9. doi: 10.33545/orthor.2021.v5.i3c.313.
30. Sathavu PP, Kothimbakkam PK, Murugan PB, Mohideen S, Murugesan V, Ranganathan T. Functional and Radiological Outcome of Proximal Humerus Fractures Treated with Proximal Humerus Internal Locking Osteosynthesis System Plating - A Prospective Study. J Orthop Case Rep. 2025;15(6): 294-9. doi: 10.13107/jocr.2025.v15.i06.5742. [PubMed: 40520751]. [PubMed Central: PMC12159620].
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| Issue | Vol 12 No 2 (2026) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v12i2.21516 | |
| Keywords | ||
| Proximal Humerus Fractures Internal Fixation | ||
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How to Cite
1.
Sharma A, DasGupta B, Patel M, Shinde M, Jethliya S, Revankar S, Garg D, Bahl R, Yogeshwari P, Mitra S, Chunawala S, Singh Y, Akanksha S. Functional Outcome of Displaced Proximal Humerus Fractures Managed by Proximal Humerus Interlocking System Plate. J Orthop Spine Trauma. 2026;12(2):102-6.
