Comparative Analysis of Proximal Humerus Fracture Outcomes with PHILOS Plating Alone and with Autologous Fibular Bone Graft

Abstract

Proximal humeral fractures (PHFs) are prevalent in older populations due to osteoporosis, often requiring surgical intervention in complex cases. Traditional management with the Proximal Humeral Internal Locking System (PHILOS) plate has shown effectiveness; however, it may fall short in severe cases where additional support is needed. This study compares outcomes of PHILOS plating alone versus PHILOS plating augmented with autologous non-vascularized fibular bone graft. The primary aim was to assess and compare functional outcomes, fracture union, and complication rates between these two treatment groups. This prospective study included patients diagnosed with PHFs, classified under Neer's system, and treated either with PHILOS plating alone (Group A) or with PHILOS plating augmented by fibular grafting (Group B). Both groups underwent Open Reduction Internal Fixation using a deltopectoral approach. Postoperative assessments were performed at 15 days, 6 weeks, 3 months, and 6 months, measuring parameters like Visual Analogue Scale (VAS) scores, Activities of Daily Living (ADL), and range of motion. Patients treated with fibular grafting showed superior long-term functional recovery, particularly in complex fractures. Though early postoperative morbidity was higher in Group B, functional outcomes improved significantly over time compared to Group A. The augmented approach also demonstrated improved fracture stability and alignment, reducing fixation failure rates. This study suggests that fibular bone grafting with PHILOS plating may offer better outcomes in terms of pain relief, structural stability, and functional improvement for severe PHFs. However, further research with larger sample sizes and longer follow-ups is recommended to validate these findings and optimize surgical protocols.