Comparative analysis of proximal humerus internal locking system plating and external fixation in proximal humerus fracture management: a prospective study on functional outcomes

Background: The management of proximal humerus fractures presents challenges due to their intricate anatomy and varied fracture patterns in NEER’S type 3,4. This prospective study aimed to compare functional outcomes between proximal humerus internal locking system (PHILOS) plating and external fixation ((UMEX). Methods: Fifteen patients in each group, classified as NEER type 3 and 4 fractures were included. Patient demographics showed no significant age or gender differences between the groups. Patients’ selection was randomized. Results: Functional assessment using disabilities of the arm, shoulder, and hand (DASH) scores revealed superior outcomes in the external fixator group at 6 weeks (55.54±6.50 vs. 50.50±6.10), 3 months (66.91±5.34 vs. 61.67±7.08), and 6 months (77.83±2.79 vs. 65.29±5.15), with significant differences observed (p=6 weeks: 0.0370, 3 months: 0.0299, 6 months: <0.0001). Similarly, visual analogue score (VAS) scores demonstrated lower postoperative pain levels in the external fixator group at 6 weeks (2.85±1.21 vs. 4.14±1.10) and 6 months (0.33±0.52 vs. 1.00±0.58), with significant differences noted (p=0.0049 and p=0.0024). Furthermore, regarding range of motion, the external fixator group consistently outperformed the PHILOS group across all measured shoulder movements at 3 and 6 months, showing significant differences (abduction: p=0.0127, extension: p<0.0001, external rotation: p=0.0004, internal rotation: p=0.0002, flexion: p<0.0001). Conclusions: These findings underscore the potential superiority of external fixation in achieving better clinical outcomes, lower pain levels, and improved range of motion compared to PHILOS plating in proximal humerus fracture management.