Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis

OBJECTIVES: The goal of this study is to evaluate the incidence of complications and the functional outcome after open reduction and internal fixation with the proximal humeral locking plate (Philos). DESIGN: Prospective case series. SETTING: Multicenter study in 8 trauma units (levels I, II, and III) with recruitment between September 12, 2002, and January 9, 2005. PATIENTS: One hundred fifty-seven patients with 158 fractures. INTERVENTION: Open reduction and internal fixation with a Philos plate. MAIN OUTCOME MEASUREMENTS: Occurrence of postoperative complications up to 1 year and active follow-up for 1 year with radiologic assessment to observe fracture healing, alignment, reduction, avascular necrosis, and functional outcome measurements including Constant, Disabilities of the Arm, Shoulder, and Hand, and Neer scores. RESULTS: One-year follow-up rate was 84%. The incidence of experiencing any implant-related complication was 9% and 35% for nonimplant-related complications. Primary screw perforation was the most frequent problem (14%) followed by secondary screw perforation (8%) and avascular necrosis (8%). After 1 year, a mean Constant score of 72 points (87% of the contralateral noninjured side), a mean Neer score of 76 points, and a mean Disabilities of the Arm, Shoulder, and Hand score of 16 points were achieved. CONCLUSIONS: Fixation with Philos plates preserves achieved reduction, and a good functional outcome can be expected. However, complication incidence proportions are high, particularly due to primary and secondary screw perforations into the glenohumeral joint, with an overall complication rate of 35%. More accurate length measurement and shorter screw selection should prevent primary screw perforation. Awareness of obtaining anatomic reduction of the tubercles and restoring the medial support should reduce the incidence of secondary screw perforations, even in osteopenic bone.