Proximal Humerus Internal Locking System (PHILOS) Plating Versus External Fixation Using Kirschner Wires (K-Wires) With Frames for Proximal Humerus Fractures: A Prospective Comparative Study.

BACKGROUND

Proximal humerus fractures are among the most common fractures involving the shoulder and frequently require surgical intervention when displaced or unstable. Among the available fixation techniques, open reduction and internal fixation using proximal humerus internal locking system (PHILOS) plates and external fixation using Kirschner wires (K-wires) and frames are commonly employed. However, evidence comparing their clinical and functional outcomes remains limited, particularly in the Indian population.

METHODS

This prospective comparative observational study was conducted at Government Doon Medical College and associated Doon Hospital, Dehradun, India, over a period of 15 months. Sixty adult patients with proximal humerus fractures were included: 30 treated with PHILOS plating (MEDPLUS, Ahmedabad, India) and 30 with external fixation using K-wires and frames (MEDPLUS, Ahmedabad, India). Baseline demographic, clinical, and fracture characteristics were recorded. Functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at one, three, and six months postoperatively. Secondary outcomes included operative duration, intraoperative blood loss, fluoroscopy exposure, hospital stay, time to radiological union, shoulder range of motion, and complications.

RESULTS

Radiological union rates were comparable between groups. By 16 weeks, union was achieved in 27/30 patients (90.0%) in the PHILOS group and 25/30 patients (83.3%) in the K-wires with frames group; no patient in either group developed non-union. Functional outcomes favored PHILOS plating. QuickDASH scores were significantly lower at three months (31.80 ± 9.88 vs. 37.60 ± 8.11, p = 0.016) and six months (16.89 ± 8.48 vs. 22.59 ± 8.54, p = 0.012). Patients treated with PHILOS plating also demonstrated significantly greater forward flexion (142.60 ± 18.40° vs. 131.76 ± 21.65°, p = 0.041) and abduction (136.87 ± 20.15° vs. 124.70 ± 22.51°, p = 0.031) at six months. Repeated-measures analysis demonstrated significant improvement in QuickDASH scores over time, F(1.565, 90.770) = 1958.187, p <0.001, and significantly lower overall QuickDASH scores in the PHILOS plating group, F(1, 58) = 5.774, p = 0.019; however, the time × treatment group interaction was not significant. Overall complication rates were identical, occurring in 8/30 patients (26.7%) in each group. Fracture complexity, comorbidities, and postoperative complications were significantly associated with poorer functional outcomes.

CONCLUSIONS

Both PHILOS plating and external fixation using K-wires with frames achieved satisfactory fracture union and functional recovery. However, patients treated with PHILOS plating demonstrated better functional outcomes, earlier painless mobilization, and improved shoulder range of motion despite longer operative time, greater blood loss, and prolonged hospitalization. PHILOS plating may therefore be the preferred treatment option for appropriately selected proximal humerus fractures.