Objective: To assess the outcome of Neer type 3 and 4 fractures of humeral head treated with Proximal Humerus Internal Locking System (PHILOS) plating.

Study Design: Descriptive case series.

Place and Duration: This study was conducted in The Department of Orthopaedics and Spine Surgery, Lahore General Hospital, Postgraduate Medical Institute, Lahore Pakistan from 1^st September 2020 to 30^th March 2022.

Methodology: A total of 30 patients aged between 18-60 years presenting with displaced three and four parts fractures of proximal humerus were analyzed. At the time of enrollment, demographic data was noted and medical history was taken. All fractures were classified with the help of plain radiographs. All patients underwent PHILOS Plate osteosynthesis as per standard surgical approach. The patients were followed up till 6-months. Final outcomes were labeled in terms of total constant score and functional outcome.

Results: In a total of 30 cases, 73.3% were male while overall mean age was 36.73±12.85 years. There were 56.7% patients who had road traffic accident and 36.7% reported fall from height and 6.7% patients had physical assault (hit by bull). The mean duration of surgical procedure was 59.57±19.39 minutes while the mean duration of hospitalization was 5.50±2.17 days. The mean constant score was 72.76±12.25. The functional outcome of patients after 6 months were excellent in 10.0% patients, good 40.0% and 50.0% had fair outcome. There were 93.3% patients who had grade-1 union and 6.7% had grade-2 union after 6 months of follow up.

Conclusion: Very acceptable functional outcomes with PHILOS plating were found in Neer type 3 and 4 fractures of humeral head. Early mobilization of shoulder can be achieved without any compromise in fracture union with six months follow and there was no avascular necrosis.  

Keywords: Accidents, Hospitalization, Humerus, Necrosis, Shoulder, Surgical Procedures, Proximal Humerus Internal Locking System (PHILOS) Plating

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