title: Clinical longer-term results after internal fixation of proximal humerus fractures with a locking compression plate (PHILOS).
abstract: OBJECTIVE
  The aim of this study was to investigate the subjective and objective longer-term outcomes after fracture fixation with the Proximal Humerus InterLocking OSteosynthesis (PHILOS) plate.
  
  
  METHODS
  Minimum 4-year follow-up of a primary prospective cohort study.
  
  
  METHODS
  Single university trauma center.
  
  
  METHODS
  Sixty-four consecutively collected patients fulfilled the study criteria. Seven patients (11%) were lost to follow-up, resulting in 57 patients (65 ± 14 years).
  
  
  METHODS
  Open reduction and internal fixation with the PHILOS® plate.
  
  
  METHODS
  Standardized follow-up including functional outcome instruments (eg, Constant Murley score, Disabilities of the Arm, Shoulder and Hand), rate of complications, and secondary surgeries at 6, 12, and no less than 48 months (uni- and multivariate analysis; P < 0.05).
  
  
  RESULTS
  At the 4- to 6-year follow-up (median 5 years postinjury), patients on average achieved an 87% range of motion of the injured compared with the uninjured shoulder (eg, 133° ± 40° versus 152° ± 26° abduction). Objective and subjective outcome improved significantly during the overall follow-up, most of all in reoperated and younger patients (65 years and younger) and within the first postinjury year. We observed an overall reoperation rate of 29% and 10 patients (17.5%) demonstrated an insufficient result resulting from pain (greater than 3 visual analog scale) or restricted abduction (less than 90°) at longer-term follow-up. First, the need for revision surgery and, second, increasing age were found to be the most predictive factors for unsatisfactory results.
  
  
  CONCLUSIONS
  Fracture fixation with the PHILOS showed good to excellent longer-term results in three fourths of patients with outcome partially still improving after the first postoperative year.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Kantonsspital Bruderholz, Bruderholz, Switzerland. michael.hirschmann@ksbh.ch
authors.forename: Michael Tobias
authors.initials: MT
authors.lastname: Hirschmann
authors.forename: Basil
authors.initials: B
authors.lastname: Fallegger
authors.forename: Felix
authors.initials: F
authors.lastname: Amsler
authors.forename: Pietro
authors.initials: P
authors.lastname: Regazzoni
authors.forename: Thomas
authors.initials: T
authors.lastname: Gross
mesh_terms: D000368:Aged; D001860:Bone Plates; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness; D010146:Pain; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012086:Reoperation; D012784:Shoulder Fractures / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D014193:Trauma Centers; D016896:Treatment Outcome