Surgical management of complex humerus head fractures

The locked plate systems provided adequate fixation of osteoporotic fractures of the proximal humerus in the elderly. But is the PHILOS plate adequate for stabilization of high-energy fractures, and fracture-dislocations of the proximal humerus in relatively younger age populations? In this retrospective study, performed at a referral, academic supervised, level III-trauma center, all high-energy trauma patients under the age of 55 years, with closed, 3 part, 4 part fractures, and/or fracture dislocations, were included in this study. Patients with open fractures, osteoporotic low-energy fractures, as well as patients older than 55 years were excluded. Fifty-nine patients entered and completed the study. They were all managed by open reduction and internal fixation using the PHILOS plate system. Patients' age ranged between 31-52 years, with a mean of 42 years. A minimal follow-up period of two years was a mandatory inclusion criterion in this study. All the patients who did not complete the follow-up period were excluded from the study. The results were evaluated using the Constant, Neer and DASH scoring systems, which revealed favorable results in 41 patients (69.5%). The results were comparable to the recent articles published in the literature in relatively older age groups. It was concluded that, 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 polytrauma patients.