Orthopaedic and Trauma Surgery, Hospital de Sant Boi de Llobregat, Barcelona, Spain

Purpose: The method of treatment of unstable and displaced fractures of the proximal humerus is a controversial topic. Systems locked plate screws offer biomechanical advantages. We present our results after fracture fixation in three and four parts with two types of plates with angular stability: The PHILOS plate and the Depuy S3 plate.

Material and Methods: 36 patients (25 female, 11 male, mean age : 60 years ; range 30 to 83 years) with three (24) and four (12) part proximal humerus fractures (Neer Cl.) were operated using the PHILOS plate (18 c.) and the Depuy S3 plate (18 c.). The mean follow-up time was 18 postoperative months (range : 6 to 50 months).

Results: The surgical approach was deltopectoral. No intraoperative complications were reported. The outcomes were assessed using the Constant Score. The fracture united clinically and radiologically in all cases. Complications : in two cases showed a transient axillary nerve palsy. Four patients had intra- articular protrusion of screws (3 in the PHILOS group and 1 in the S3 group). One patient had osteonecrosis of the humeral head (in the PHILOS group). There were no cases of infection or material failure. According to the Constant score in 8 patients the result was excellent, 20 good and 8 is not satisfactory. There was no significant difference in the Constant score between patients over 65 years and those younger than 65 years.

Conclusion: Osteosynthesis using plates with angular stability provided some encouraging results for the management of complex fractures. Screw cutout with intra-articular location remains a problem in the PHILOS group.