Evaluation of results of three and four-part fracture dislocations of proximal humerus in young adults using philos (proximal humerus internal locking system)


  • Amit Thakur Department of Orthopaedics GMC, Jammu and Kashmir, India
  • Khalid Muzzafar Department of Orthopaedics GMC, Jammu and Kashmir, India
  • Sumeet Singh Charak Department of Orthopaedics GMC, Jammu and Kashmir, India
  • Bias Dev Department of Orthopaedics GMC, Jammu and Kashmir, India
  • Abdul Ghani Department of Orthopaedics GMC, Jammu and Kashmir, India




Fracture dislocation shoulder, PHILOS plate, Proximal humerus fractures


Background: The fractures of proximal humerus constitute about 5% of fractures in adults third in number to fracture colles and hip usually in elderly patients due to a low energy trauma. In young patients the fractures are mostly due to high energy trauma and as such are associate with other soft tissue injuries. A sub group of young patients have a three or four fracture dislocation of shoulder joint. The aim of this study was to find the results of fixation by PHILOS in these young patients.

Methods: This study was done in a teritiary referral centre over a period of about 1 year. All patients were operated within three weeks. Open fractures, patients with age more than 50 years were excluded from the study. All patients underwent open reduction and fixation using commercially available PHILOS. A minimum of 6 months follows up was essential for inclusion into the study. Final functional results were evaluated by Constant Murley scoring.

Results: 14 patients were included in the study. The average age of patients was 38.42years. All fractures united. We had 71.4% excellent or good results. The complications noted were shoulder stiffness in 3, inadequate post op reduction, rotator cuff insufficiency, head necrosis, secondary osteo arthritis 1 each.

Conclusions: Despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of these patients.


Neer CS. II: Displaced proximal humeral fractures: Part I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077-89.

Habermeyer P, Schweiberer L. Fractures of the proximal humerus. Orthopade. 1989;18:200-7.

Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury. 2003;34:63-76.

Flatow EL. Fractures of the proximal humerus. Rockwood and Greens fractures in adults. In: Bucholz RW, Heckman JD, editors. Vol. 1. Philadelphia: Lippincott, Williams and Wilkins;2001:997-1035.

Perez EA. Fractures of the shoulder, arm, and forearm. Canale ST, Beaty JH. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, Pa: Mosby Elsevier. 2012.

Baron JA, Barrett JA, Karagas MR. The epimediology of peripheral fractures. Bone. 1996;18:209S-213.

Brian LB, Mark M. Fixed-angle locked plating of two-, three-, ìand four-part proximal humerus fractures. J Am Acad Orthop Surg. 2008;16:294-302.

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-4.

Fabre T, Piton C, Leclouerec G, Gervais-Delion F, Durandeau A. Entrapment of the suprascapular nerve. J Bone Joint Surg Br. 1999;81(3):414-9.

Weinstein DM, Bratton DR, Ciccone WJ, Elias JJ. Locking plates improve torsional resistance in the stabilization of three-part proximal humeral fractures. J Shoulder Elbow Surg. 2006;15(2):239-43.

Edwards SL, Wilson NA, Zhang LQ, Flores S, Merk BR. Two-part surgical neck fractures of the proximal part of the humerus: a biomechanical evaluation of two fixation techniques. JBJS. 2006;88(10):2258-64.

Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: A retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75:741-5.

Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. Treatment of proximal humeral fractures with the PHILOS angular stable plate. Presentation of 225 cases of dislocated fractures. Der Unfallchirurg. 2006;109(12):1032-40.

Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clinical orthopaedics and related research. 2005;430:176-81.

Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J orthopaedic trauma. 2009;23(3):163-72.

Helwig P, Bahrs C, Epple B, Oehm J, Eingartner C, Weise K. Does fixed-angle plate osteosynthesis solve the problems of a fractured proximal humerus? A prospective series of 87 patients. Acta orthopaedica. 2009;80(1):92-6.

Shahid R, Mushtaq A, Northover J, Maqsood M. Outcome of proximal humerus fractures treated by PHILOS plate internal fixation. Experience of a district general hospital. Acta Orthopaedica Belgica. 2008;74(5):602.

Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg Br. 2007;89:1206-9.




How to Cite

Thakur, A., Muzzafar, K., Charak, S. S., Dev, B., & Ghani, A. (2018). Evaluation of results of three and four-part fracture dislocations of proximal humerus in young adults using philos (proximal humerus internal locking system). International Journal of Research in Medical Sciences, 6(2), 585–590. https://doi.org/10.18203/2320-6012.ijrms20180303



Original Research Articles