Secure fixation of displaced proximal fractures of the humerus is a challenging problem. A total of 32 patients with acutely displaced three- or four-part proximal fractures of the humerus were treated by open reduction and internal fixation using the proximal humeral internal locking system (PHILOS) plate. There were 23 women and nine men with a mean age of 59.9 years (18 to 87). Data were collected prospectively and the outcomes were assessed using the Constant score. The mean follow-up was for 11 months (3 to 24). In 31 patients (97%) the fracture united clinically and radiologically at a mean of 10 weeks (8 to 24). The mean Constant score at final review was 66.5 (30 to 92). There was no significant difference in outcome when comparing patients aged more than 60 years (18 patients) with those aged less than 60 years (14 patients) (t-test, p = 0.8443). There was one case each of nonunion, malunion and a broken screw in the elderly population.

This plate provides an alternative method of fixation for fractures of the proximal humerus. It provides a stable fixation in young patients with good-quality bone sufficient to permit early mobilisation. Failure of the screws to maintain fixation in the elderly remains a problem.

Introduction. A review of the literature showed a discrepancy between biomechanical and clinical studies on fracture fixation failure in patients with poor bone quality. The objective of the present study is to assess the influence of local bone status on complications after surgical treatment of proximal humerus fractures. Methods. A prospective cohort study was initiated in 2007. The inclusion criteria were closed displaced fractures of the proximal humerus, primary fracture treatment with a Philos plate, patients aged 50 to 90, normal pre-trauma function of both shoulders in accordance to age, and monotrauma. There was active follow-up for one year with radiological assessment at clinical centers from four countries. Bone quality at the proximal humerus was determined preoperatively for the contralateral side of the fracture by CT scan, and at the contralateral radius within six weeks post-surgery by DXA. The occurrence of complications was monitored up to one year post-surgery. Independent x-ray evaluation and final classification of all complications will be performed at the end by a study review board using anonymous data and x-rays. Preliminary Results. 157 patients, 127 female (79%) met the inclusion criteria. Their mean age at time of surgery is 69 (range 50–89). 119 patients (100%) attended the 1-year follow-up assessment, 64 (96%) the one at 3 months, and 148 (99%) the 6 week follow-up examination. According to the WHO criteria, 107 patients (71%) suffered from either osteopenia or osteoporosis, while 43 patients (29%) had a normal T-score. The overall reported complication rate was 39%. However, the number of intraoperative complications was 0.6%, bone/fracture complications 19.1%, implant complications 15.3%, and general complications 14.6%. Discussion. Fixation of proximal humerus fractures with Philos plates in elderly people with osteoporotic bone is associated with a high rate of fixation failure. Final results will be reported after x-rays, local BMD (CT- based) and complications assessment have been conducted

Introduction. Proximal humeral shaft fractures are rare injury. In such case, to the best of our knowledge, the treatment by both double-plate method and the MIPO has never been seen before in the literature. Here we report our experience and management about this method. Materials & Methods. A 69-year-old man who suffered falling down at home to his right shoulder that resulted in co-existing fractures of the proximal humerus and humeral shaft. According to AO/ASIF classification, he had 11-B1 and 12-A1 fractures ipsilaterally. He was treated by double plate method with PHILOS (SYNTHES, Japan) to proximal humerus and narrow LC-LCP(SYNTHES, Japan) to humeral shaft. Intraoperatively we put the skin incision about 3.0 cm each in three places, for reduction and fixation by the MIPO. Postoperatively, external fixation was only sling and physiotherapy was initiated after third post-operative days for range of motion exercises. Results. Union was achieved after 3.0 months and, at follow-up 1 year after injury, he had no pain and a good range of shoulder movement. Constant-Murley score was 90 points. Also he had no complication such as avascular necrosis and implant failure. Discussion & Conclusion. In this case, less invasive and rigid fixation by this method could result in early mobilization of the shoulder, relatively early union and a good functional outcome. Double-plate method with the MIPO might be one valid option in the treatment of proximal humeral shaft fractures

Aims

A pragmatic multicentre randomised controlled trial (PROFHER) was conducted in United Kingdom National Health Service (NHS) hospitals to evaluate the clinical effectiveness and cost effectiveness of surgery compared with non-surgical treatment for displaced fractures of the proximal humerus involving the surgical neck in adults.