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Background <p>This study aimed to examine the outcomes of proximal humerus internal locking system (PHILOS) with allogeneic fibular support for treating Neer Type III and IV proximal humeral fracture with associated glenohumeral dislocation (PHFD) in elderly patients.</p> Methods <p>A retrospective analysis was performed on elderly patients with osteoporosis and diagnosed as PHFD from January 2019 to June 2023. Functional assessments including evaluating the range of motion (ROM) of the shoulder joint (forward elevation and abduction), pain levels using the Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score (CMS). Radiological outcomes including humeral head height (HHH), loss of HHH, neck-shaft angle (NSA), and loss of NSA.</p> Results <p>A total of 13 patients were enrolled in this study. All patients presented with PHFD resulting from traumatic incidents and underwent open reduction and internal fixation (ORIF) with an average waiting time of 3.2 ± 1.2 days before surgery. The average follow-up duration was 16.5 ± 2.7 months. Postoperatively, the mean NSA was 124.5 ± 12.7° and the mean HHH was 9.4 ± 1.4&#xa0;mm. At the last follow-up, the mean loss of NSA was 2.2 ± 1.5° and the average loss of HHH measuring 1.3 ± 1.0&#xa0;mm. One case was classified as loss of fixation with NSA loss exceeding 5° and HHH loss greater than 3&#xa0;mm. At the final follow-up, the average VAS score was 1.4 ± 1.2, with a mean CMS of 80.7 ± 8.5 and an average ASES score of 77.8 ± 8.4. The average forward elevation reached 147.7 ± 25.5°, while the average abduction was 134.6 ± 27.3°.</p> Conclusion <p>The use of PHILOS and fibular allografts provides effective support for the medial column of the proximal humerus and humeral head in the treatment of three- and four-part PHFD in elderly patients. This approach aids in intraoperative fracture reduction, minimizes the loss of humeral head height, and reduces the occurrence of varus deformity, contributing positively to the overall satisfaction the treatment of PHFD.</p>

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Evaluating the outcomes of PHILOS with allogeneic fibular support for treating Neer type III and IV proximal humeral fractures with associated glenohumeral dislocation in elderly patients

  • 期刊论文

  • 发表日期：

    2025年11月3日

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  • Bin Zhu,
  • Bowen Cai,
  • Kaixiao Xue,
  • Jiahu Fang

摘要

Background

This study aimed to examine the outcomes of proximal humerus internal locking system (PHILOS) with allogeneic fibular support for treating Neer Type III and IV proximal humeral fracture with associated glenohumeral dislocation (PHFD) in elderly patients.

Methods

A retrospective analysis was performed on elderly patients with osteoporosis and diagnosed as PHFD from January 2019 to June 2023. Functional assessments including evaluating the range of motion (ROM) of the shoulder joint (forward elevation and abduction), pain levels using the Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score (CMS). Radiological outcomes including humeral head height (HHH), loss of HHH, neck-shaft angle (NSA), and loss of NSA.

Results

A total of 13 patients were enrolled in this study. All patients presented with PHFD resulting from traumatic incidents and underwent open reduction and internal fixation (ORIF) with an average waiting time of 3.2 ± 1.2 days before surgery. The average follow-up duration was 16.5 ± 2.7 months. Postoperatively, the mean NSA was 124.5 ± 12.7° and the mean HHH was 9.4 ± 1.4 mm. At the last follow-up, the mean loss of NSA was 2.2 ± 1.5° and the average loss of HHH measuring 1.3 ± 1.0 mm. One case was classified as loss of fixation with NSA loss exceeding 5° and HHH loss greater than 3 mm. At the final follow-up, the average VAS score was 1.4 ± 1.2, with a mean CMS of 80.7 ± 8.5 and an average ASES score of 77.8 ± 8.4. The average forward elevation reached 147.7 ± 25.5°, while the average abduction was 134.6 ± 27.3°.

Conclusion

The use of PHILOS and fibular allografts provides effective support for the medial column of the proximal humerus and humeral head in the treatment of three- and four-part PHFD in elderly patients. This approach aids in intraoperative fracture reduction, minimizes the loss of humeral head height, and reduces the occurrence of varus deformity, contributing positively to the overall satisfaction the treatment of PHFD.