Publication:

Functional outcomes of proximal humerus internal locking system plating with tension suture fixation for proximal humerus fractures: a prospective study

Background Proximal humerus fractures are increasingly common injuries, particularly among the elderly osteoporotic population. While the majority of these fractures are undisplaced and can be managed conservatively, displaced fractures often require surgical intervention to restore anatomical alignment and function. The proximal humerus internal locking system (PHILOS) has become a standard implant for these injuries, but outcomes can vary. This study evaluates the functional outcomes of displaced proximal humerus fractures treated with PHILOS plating augmented by tension suture fixation.

Methods A prospective study was conducted on 30 patients with displaced proximal humerus fractures between September 2020 and August 2022 at a tertiary care centre. Patients underwent open reduction and internal fixation through a deltopectoral approach under fluoroscopic guidance. The surgical technique involved the use of a PHILOS plate combined with tension sutures to stabilise the tuberosities and neutralise the deforming forces of the rotator cuff. Functional outcomes were assessed using the Constant-Murley Score after at least 6 months of follow-up.

Results The mean age of the study population was 53 years, with a female preponderance (73.3%). The most common injury pattern was Neer’s 3-part fracture (43.3%). The mean Constant Score at the final follow-up was 77.4. Excellent or good functional outcomes were achieved in 83.3% of patients (7 excellent, 18 good). Complications were minimal, with superficial wound infection in 10% of cases and shoulder stiffness in 3.3%.

Conclusions The combination of PHILOS plating and tension suture fixation provides rigid, stable fixation and allows for early mobilisation. This technique effectively restores the anatomy of the articular surface and the tuberosities, yielding satisfactory functional outcome with a low complication rate, making it a reliable treatment option for displaced proximal humerus fractures in the elderly.