Osteosynthesis of Proximal Humeral Fractures with the Fixed Angle PHILOS-plate.

In a retrospective study we analyzed the functional and radiological outcome of 30 proximal humeral fractures, treated by PHILOS-plate, a fixed-angle device. Two of them were characterized as type Neer III, 14 as type Neer IV, 5 as type Neer V and 9 as type Neer VI. There were 2 2-part, 16 3-part and 12 4-part fractures. According to the constant-score, the normalized constant-score and the UCLA-score, good to excellent results were obtained in 66.7, 76.7 and 76.7%. Twenty-six (86.7%) patients had no or mild pain. Active forward flexion and active abduction over 90° was possible in 26 (86.7%) cases. Four (13.3%) patients developed partial avascular necrosis. Screw perforation was seen in 3 (10%) cases, delayed union in 1 (3.3%) case, malunion in 1 case and a loosening of plate and screws in another one. A secondary varus displacement of 5°-35° with a mean of 7° was found in 19 (63.3%) cases. The average time to union was 75 days. Fixation with PHILOS-plate is an adequate treatment for displaced 2- to 4-part fractures. Even in dislocated or 4-part fractures or in patients over 65 years good to excellent results were seen in the majority of cases.