Functional Outcome of Surgical Management of Three-part and Four-part Proximal Humerus Fractures Using PHILOS Plate: A Prospective Study

Background: Proximal humerus fractures are frequently encountered injuries, particularly among the elderly with osteoporotic bones. Complex three-part and four-part fractures present unique treatment challenges. Surgical management using locking plates, notably the Proximal Humeral Internal Locking System (PHILOS™) plate, offers stable fixation and promotes early mobilisation. Methods: This prospective study included 24 adult patients with Neer type three-part and four-part proximal humerus fractures who underwent open reduction and internal fixation (ORIF) with PHILOS™ system plating. Demographic data, fracture type, side affected, mechanism of injury and complications were documented. Functional outcomes were evaluated using the Constant-Murley score at 6 weeks, 3 months, 6 months and 12 months postoperatively. Statistical analysis was conducted using statistical package for the social sciences (SPSS) software. Results: The mean patient age was 50.95 years. Females comprised 58.3% of the cohort. Right-sided involvement was more common (58.3%). Road traffic accidents (RTA) (66.7%) were the predominant mechanism of injury. Nineteen patients had three-part fractures, whereas five had four-part fractures. At 1 year, 33.3% had excellent outcomes, 62.5% had good outcomes and 4.2% had poor outcomes. One patient developed shoulder stiffness due to non-compliance with physiotherapy. No cases of infection, avascular necrosis (AVN), nonunion or implant failure were noted. Conclusions: ORIF with PHILOS™ plate is a reliable method for managing complex proximal humerus fractures, yielding favourable functional outcomes and low complication rates. Success hinges on anatomical reduction, stable fixation and dedicated rehabilitation.