Clinical and radiological outcomes of proximal humerus fracture fixation with PHILOS plate

Background: Proximal humerus fractures account for approximately 5–6% of all adult fractures. Surgical management of displaced fractures remains challenging because of fracture complexity, poor bone quality, and the need for stable fixation. The proximal humerus internal locking system (PHILOS) plate provides angular stability and has become a widely accepted fixation method. This study evaluated the clinical and radiological outcomes of displaced proximal humerus fractures treated with PHILOS plate. Methods: A retrospective study was conducted on 182 patients with displaced proximal humerus fractures fixed with PHILOS plate from January 2014 to December 2024. According to Neer's classification, 33 fractures were two-part, 84 were three-part, and 65 were four-part injuries. Functional outcomes were assessed using the Constant-Murley Score while radiological evaluation included fracture union, implant position, maintenance of reduction, and postoperative complications. Results: Mean age of patients was 47.70±13.96 years with mean follow-up of 21.24±19.85 months. Radiological union was achieved in all patients, with a mean union time of 18.13±4.62 weeks. Mean Constant-Murley Score was 74.89±13.54 points. Functional outcomes were excellent in 48 patients, good in 89, fair in 25, and poor in 20 patients. Overall complication rate was 14.29%, with varus collapse being the most common complication, followed by infection, humeral head resorption, avascular necrosis, and post-traumatic arthritis. Conclusion: PHILOS plating provided reliable fixation, fracture union, and satisfactory functional outcomes in displaced proximal humerus fractures. Restoration of medial support, accurate reduction, inferomedial calcar fixation, and structured rehabilitation are essential for optimizing outcomes and minimizing complications.