1887
Volume 2025, Issue 3
  • ISSN: 1999-7086
  • E-ISSN: 1999-7094

Data on the functional outcomes and shoulder stiffness following treatment with proximal humeral internal locking system (PHILOS) plates for proximal humerus fractures (PHFs) are limited. This study aims to evaluate the functional outcomes and postoperative shoulder stiffness, as well as their predictors, in PHF patients treated with PHILOS plates.

This retrospective study included 53 patients with PHF who underwent surgical treatment using PHILOS plates between January 2021 and January 2023. The primary endpoint measured was the Constant-Murley Score (CMS) and its associated factors, while secondary outcomes included variables related to shoulder stiffness.

Over a mean follow-up period of 19.6 ± 4.0 months, the union was achieved in 47 patients (89.3%). The mean postoperative CMS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were 83.6 ± 10.4 and 23.6 ± 6.93 points, respectively. The CMS was rated excellent in 18 patients (34.0%), good in 20 patients (37.7%), fair in nine patients (17.0%), and poor in six patients (11.3%). Complications arose in 34% of patients, notably shoulder stiffness (22.6%), followed by screw penetration and varus malunion (both 5.7%). Postoperative CMS was positively associated with DASH score ( = 5.35, < 0.001) and comorbidities ( = 2.88, = 0.003). Conversely, it was negatively associated with age ( = −3.22, = 0.014) and complications ( = −3.40, = 0.005). In multivariate analysis, only high-energy injuries were identified as independent predictors of shoulder stiffness (adjusted odds ratio, 10.07 [95% CI, 1.06–95.81]; = 0.045).

PHILOS plating demonstrates a reliable approach for managing PHFs, achieving a commendable union rate of 89.3% and positive functional outcomes. Postoperative CMS results are significantly affected by patient comorbidities and specific fracture characteristics. Furthermore, the predictive value of high-energy injuries on shoulder stiffness is crucial in devising targeted strategies to optimize recovery and reduce complications. These insights emphasize the importance of tailoring treatment plans to individual patient profiles, thereby enhancing the overall effectiveness of PHF management.

© 2025 Almirah, Alkholidy, Alrabeei, Abdulmughni, Hutaif, Ahmed, licensee HBKU Press.
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References

  1. Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, et al. 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 Jun; 91:(6):1320–8. https://doi.org/10.2106/JBJS.H.00006
     [Google الباحث العلمي]
  2. Baker HP, Gutbrod J, Strelzow JA, Maassen NH, Shi L. Management of proximal humerus fractures in adults-a scoping review. J Clin Med. 2022 Oct 18; 11:(20):6140. https://doi.org/10.3390/jcm11206140
     [Google الباحث العلمي]
  3. Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2022 Jun 21; 6:(6):CD000434. https://doi.org/10.1002/14651858.CD000434.pub5
     [Google الباحث العلمي]
  4. 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 Jun; 15:: 129–37. https://doi.org/10.2147/ORR.S340536
     [Google الباحث العلمي]
  5. Ricchetti ET, Warrender WJ, Abboud JA. Use of locking plates in the treatment of proximal humerus fractures. J Shoulder Elbow Surg. 2010 Mar; 19:(2 Suppl):66–75. https://doi.org/10.1016/j.jse.2010.01.001
     [Google الباحث العلمي]
  6. Marsalli M, De La Paz J, Córdova C, Fritis D, Errázuriz JD. Complications of locked plating for proximal humeral fractures in active patients in a level one trauma center. Shoulder Elbow. 2023 Apr; 15:(2):181–7. https://doi.org/10.1177/17585732221079588
     [Google الباحث العلمي]
  7. Bel JC. Pitfalls and limits of locking plates. Orthop Traumatol Surg Res. 2019 Feb; 105:(1S):S103–S9. https://doi.org/10.1016/j.otsr.2018.04.031
     [Google الباحث العلمي]
  8. 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 Aug; 29:(8):1689–94. https://doi.org/10.1016/j.jse.2019.11.026
     [Google الباحث العلمي]
  9. Fisher ND, Driesman A, Saleh H, Egol KA, Konda SR. The proximal humerus outcome score at one year (POSY) predicts which patients have poor functional outcomes following operative fixation of proximal humerus fractures. Cureus. 2022 Jul; 14:(7):e26631. https://doi.org/10.7759/cureus.26631
     [Google الباحث العلمي]
  10. Agrawal U, K VB, Rao HK, R PK, Narayandas DK. Assessment of functional outcome and postoperative complications in proximal humerus fracture patients managed with proximal humerus internal locking system (PHILOS) plating. Cureus. 2024 Jun; 16:(6):e63250. https://doi.org/10.7759/cureus.63250
     [Google الباحث العلمي]
  11. 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 Sep 25; 12:(1):137. https://doi.org/10.1186/s13018-017-0639-3
     [Google الباحث العلمي]
  12. Mathew G, Agha R, Albrecht J, Goel P, Mukherjee I, Pai P, et al. STROCSS 2021: Strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int J Surg. 2021 Dec; 96:: 106165. https://doi.org/10.1016/j.ijsu.2021.106165
     [Google الباحث العلمي]
  13. Carofino BC, Leopold SS. Classifications in brief: the Neer classification for proximal humerus fractures. Clin Orthop Relat Res. 2013 Jan; 471:(1):39–43. https://doi.org/10.1007/s11999-012-2454-9
     [Google الباحث العلمي]
  14. Jhamnani R, Dhanda MS, Surana A. Study of functional outcome and postoperative complications among proximal humerus fracture patients treated with proximal humerus internal locking system (PHILOS) plating. Cureus. 2023 Jul; 15:(7):e42411. https://doi.org/10.7759/cureus.42411
     [Google الباحث العلمي]
  15. Cho CH, Bae KC, Kim DH. Incidence and risk factors for early postoperative stiffness after arthroscopic rotator cuff repair in patients without preoperative stiffness. Sci Rep. 2022 Feb 24; 12:(1):3132. https://doi.org/10.1038/s41598-022-07123-5
     [Google الباحث العلمي]
  16. Wang L, Lyu F, Rong J, Sun H, Li B, Liu J. Factors influencing shoulder stiffness after open reduction and internal fixation of proximal humeral fractures. Jt Dis Relat Surg. 2024 Apr 26; 35:(2):285–92. https://doi.org/10.52312/jdrs.2024.1529
     [Google الباحث العلمي]
  17. Trikha V, Singh V, Choudhury B, Das S. Retrospective analysis of proximal humeral fracture-dislocations managed with locked plates. J Shoulder Elbow Surg. 2017 Oct; 26:(10):e293–e9. https://doi.org/10.1016/j.jse.2017.03.035
     [Google الباحث العلمي]
  18. Gupta AK, Harris JD, Erickson BJ, Abrams GD, Bruce B, McCormick F, et al. Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma. 2015 Jan; 29:(1):54–9. https://doi.org/10.1097/BOT.0000000000000229
     [Google الباحث العلمي]
  19. Goyal S, Ambade R, Singh R, Lohiya A, Patel H, Patel SK, et al. A comprehensive review of proximal humerus fractures: from epidemiology to treatment strategies. Cureus. 2024 Apr; 16:(4):e57691. https://doi.org/10.7759/cureus.57691
     [Google الباحث العلمي]
  20. 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. https://doi.org/10.3944/AOTT.2010.2270
     [Google الباحث العلمي]
  21. Kamikovski I, Wengle L, Sheth U, Nam D. Open reduction and internal fixation of the proximal humerus with femoral head allograft augmentation “the French fry technique”. JSES Rev Rep Tech. 2024 Aug; 4:(3):438–48. https://doi.org/10.1016/j.xrrt.2023.11.003
     [Google الباحث العلمي]
  22. Safwat HM, Abulsoud ME, Abdelazim AE. Internal fixation of proximal humerus fracture by PHILOS plate. Egypt J Hosp Med. 2019 Apr; 75:(1):1987–95. https://doi.org/10.21608/ejhm.2019.29172
     [Google الباحث العلمي]
  23. Adıyeke L, Geçer A, Bulut O. Comparison of effective factors in loss of reduction after locking plate-screw treatment in humerus proximal fractures. Ulus Travma Acil Cerrahi Derg. 2022 Jul; 28:(7):1008–15. https://doi.org/10.14744/tjtes.2022.28742
     [Google الباحث العلمي]
  24. Panagiotopoulou VC, Varga P, Richards RG, Gueorguiev B, Giannoudis PV. Late screw-related complications in locking plating of proximal humerus fractures: a systematic review. Injury. 2019 Dec; 50:(12):2176–95. https://doi.org/10.1016/j.injury.2019.11.002
     [Google الباحث العلمي]
  25. Huang Z, Dong H, Ye C, Zou Z, Wan W. A network meta-analysis of multiple modalities for the treatment of complex proximal humeral fractures in older adults. Injury. 2023 Oct; 54:(10):110958. https://doi.org/10.1016/j.injury.2023.110958
     [Google الباحث العلمي]
  26. Fleischhacker E, Siebenbürger G, Helfen T, Gleich J, Böcker W, Ockert B. Varus malposition relates to functional outcomes following open reduction and internal fixation for proximal humeral fractures: A retrospective comparative cohort study with minimum 2 years follow-up. Injury. 2021 Mar; 52:(3):506–10. https://doi.org/10.1016/j.injury.2020.09.003
     [Google الباحث العلمي]
  27. Gavaskar AS, Pattabiraman K, Srinivasan P, Raj RV, Jayakumar B, Rangasamy NK. What factors are associated with poor shoulder function and serious complications after internal fixation of three-part and four-part proximal humerus fracture-dislocations? Clin Orthop Relat Res. 2022 Aug 1; 480:(8):1566–73. https://doi.org/10.1097/CORR.0000000000002190
     [Google الباحث العلمي]
  28. Ye T, Wang L, Zhuang C, Wang Y, Zhang W, Qiu S. Functional outcomes following locking plate fixation of complex proximal humeral fractures. Orthopedics. 2013 Jun; 36:(6):e715–22. https://doi.org/10.3928/01477447-20130523-14
     [Google الباحث العلمي]
  29. Hardeman F, Bollars P, Donnelly M, Bellemans J, Nijs S. Predictive factors for functional outcome and failure in angular stable osteosynthesis of the proximal humerus. Injury. 2012 Feb; 43:(2):153–8. https://doi.org/10.1016/j.injury.2011.04.003
     [Google الباحث العلمي]
  30. Kugashiya M, Pipal RK, Sojitra RP, Shah JV, Pipal DK, Yadav S. Assessment of clinical and functional outcomes of the proximal humerus internal locking compression plate in different Neer’s types of proximal humeral fracture: a prospective observational study. J West Afr Coll Surg. 2024 Jul-Sep; 15:(3):298–305. https://doi.org/10.4103/jwas.jwas_55_24
     [Google الباحث العلمي]
  31. Vijayvargiya M, Pathak A, Gaur S. Outcome analysis of locking plate fixation in proximal humerus fracture. J Clin Diagn Res. 2016 Aug; 10:(8):RC01–5. https://doi.org/10.7860/JCDR/2016/18122.8281
     [Google الباحث العلمي]
  32. Harryman DT 2nd, Hettrich CM, Smith KL, Campbell B, Sidles JA, Matsen FA 3rd. A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status. J Bone Joint Surg Am. 2003 Apr; 85:(4):690–6.
    [Google الباحث العلمي]
  33. Gagnier JJ, Allen B, Watson S, Robbins CB, Bedi A, Carpenter JE, et al. Do medical comorbidities affect outcomes in patients with rotator cuff tears? Orthop J Sports Med. 2017 Aug; 5:(8):2325967117723834. https://doi.org/10.1177/2325967117723834
     [Google الباحث العلمي]
  34. Südkamp NP, Audigé L, Lambert S, Hertel R, Konrad G. Path analysis of factors for functional outcome at one year in 463 proximal humeral fractures. J Shoulder Elbow Surg. 2011 Dec; 20:(8):1207–16. https://doi.org/10.1016/j.jse.2011.06.009
     [Google الباحث العلمي]
  35. Gahlot N, Rai A, Netaji J. Constant score in asymptomatic shoulders varies with different demographic populations: derivation of adjusted score equation. Clin Shoulder Elb. 2022 Dec; 25:(4):274–81. https://doi.org/10.5397/cise.2022.00864
     [Google الباحث العلمي]
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Functional outcomes and postoperative shoulder stiffness in patients with proximal humerus fractures treated with PHILOS plating: A retrospective study
Journal of Emergency Medicine, Trauma and Acute Care 2025, 31 (٢٠٢٥); https://doi.org/10.5339/jemtac.2025.31
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  • نوع المستند: Research Article
الموضوعات الرئيسية Fracture, internal locking, PHILOS, proximal humerus fracture and shoulder stiffness after surgery

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