Minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS)

Background: This study evaluated our results after minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS, Synthes, Switzerland). Materials and methods: Between 2005 and 2008, 15 patients with unilateral displaced proximal humeral shaft fractures were treated and followed up over a median period of 27 months (range, 12-38 months). The final follow-up included anteroposterior and lateral x-rays, range of shoulder motion, pain by visual analog scale (VAS), the Constant-Murley shoulder score, the Disabilities of Arm, Shoulder and Elbow (DASH) score, and the Short Form 36 (SF36) assessment. Results: No intraoperative or postoperative complications occurred. No secondary fracture displacement or radial neuropathy was observed postoperatively. One patient had open reduction and internal fixation for pseudoarthrosis 16 months after the initial surgery. At the final follow-up, the median range of motion of the operated shoulder was flexion, 145 degrees; extension, 45 degrees; internal rotation, 40 degrees; external rotation, 70 degrees; and abduction, 135 degrees. Median results on outcome assessments were VAS pain score, 0 points; Constant-Murley score, 74 points, representing 87.5% of the median Constant-Murley score of the unaffected shoulder; DASH score, 34 points, and the SF36, 83 points. Conclusion: Minimally invasive percutaneous plating with the PHILOS offers a valid option in the treatment of proximal humeral shaft fractures with comparable rates of nonunion and lower rates of radial neuropathy compared with open procedures. Furthermore, the results indicate that this method is associated with lower rates of wound infection and a shorter stay in the hospital for the patient. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.