# Functional Outcomes of Proximal Humeral Fracture Fixation Using a Proximal Humerus Internal Locking Osteosynthesis (PHILOS) Plate with Fibular Strut Graft Augmentation: A Retrospective Review

## TL;DR

This study examines how adding a fibular graft improves outcomes in complex shoulder fractures treated with a PHILOS plate.

## Contribution

The novel contribution is evaluating fibular strut graft augmentation in proximal humeral fractures with medial calcar comminution.

## Key findings

- All 13 patients achieved fracture union with an average time of 5.2 months.
- Significant improvement in QuickDASH and VAS scores was observed at one year.
- Anatomical reduction was achieved in all patients, with only one case of mild varus alignment.

## Abstract

Introduction

Proximal humerus fractures (PHFs) are one of the most common fractures encountered in the emergency commonly affecting the elderly as a result of minimal trauma. The gold standard for a displaced PHF is plate osteosynthesis. However, many of these fractures fail due to a lack of medial calcar support. Our study evaluated the addition of a fibular strut graft on the effect on these fractures.

Methodology

A retrospective review was performed over 12 months in our institute. We included patients with three- or four-part PHFs with osteoporosis and medial calcar comminution. The patients were operated on using PHILOS plating with fibular autograft and were followed up for radiological and functional outcomes.

Results

A total of 13 patients, of whom 6 were males, were included in the study. The average age was 53.69 (41-63) years, and 9 patients had four 4-part fractures. All patients achieved union, with an average time to union being 5.2 months. There was a significant improvement in both the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and the visual analog scale (VAS) at one year. All patients achieved a near normal range of motion, and X-ray evaluation showed all fractures to be anatomically reduced at one year, with only one patient with varus alignment of 11 degrees.

Conclusions

Our study found the addition of fibular strut autograft in patients with proximal humeral fractures with medial calcar comminution as an adequate augmentation with good functional outcomes and minimal complications.