Functional Outcome Assessment of Proximal Humerus Fractures Treated with PHILOS Plating in patients of more than 60 years of age in a tertiary care centre

Abstract

Background: Proximal humerus fractures are prevalent among the elderly, primarily
due to osteoporosis and increased fall risk. Surgical intervention, particularly using
the Proximal Humerus Internal Locking System (PHILOS), has been advocated for
displaced fractures to ensure stable fixation and facilitate early mobilization.
Objective: To evaluate the functional outcomes and complication rates associated
with PHILOS plating in elderly patients (aged ≥60 years) presenting with displaced
proximal humerus fractures. Methods: This prospective observational study included
30 patients aged 60 years and above with displaced proximal humerus fractures
treated surgically using PHILOS plating between July 2024 and December 2024.
Fractures were classified according to Neer’s classification. Functional outcomes
were assessed using the Constant–Murley Score (CMS) at 6 months postoperatively.
Radiological union and postoperative complications were also documented. Results:
The mean age of patients was 68.0 ± 5.3 years. Fracture distribution was as follows:
2-part (56.7%), 3-part (30.0%), and 4-part (13.3%). The overall mean CMS at 6
months was 66.4 ± 9.7. Specifically, 2-part fractures had a mean CMS of 70.5 ± 7.1,
3-part fractures 63.6 ± 10.8, and 4-part fractures 55.3 ± 12.5. Functional outcome
grading revealed excellent outcomes in 3.3% of patients, good in 36.7%, fair in
40.0%, and poor in 20.0%. Complications were observed in 30% of patients, with
shoulder stiffness (13.3%) being the most common, followed by screw cut-out
(6.7%), varus malunion (6.7%), and avascular necrosis (3.3%). Conclusion:
PHILOS plating offers a reliable method for achieving stable fixation and
satisfactory functional outcomes in elderly patients with displaced proximal humerus
fractures, particularly in 2- and 3-part fractures. However, the complexity of 4-part
fractures is associated with increased complication rates and poorer functional
outcomes. Early physiotherapy and meticulous surgical technique are crucial for
optimizing results in this demographic.