Functional results of double plating for comminuted fractures of the proximal humerus

Introduction
The proximal humeral locked plate (PHILOS) gained great popularity in the treatment of proximal humeral fractures which constitutes one of the common osteoporotic fractures, however, recent reports about failure in the treatment of comminuted fractures and those with diaphyseal extension led to different attempts of either augmenting or adding more fixation. Double plating is common in other peri-articular fractures. In this paper, the technique of double plating of the proximal humerus by adding a second plate to the PHILOS plate is described.
Methods
Total 17 patients with comminuted fractures of the proximal humerus with diaphyseal extension treated between January 2109 and July 2022 performed at El-Hadra University Hospital with adding either a small locked dynamic compression plate or a small locked reconstruction plate with the standard PHILOS plate through the trans-deltoid approach.
Results
The mean of the duration of the follow-up was 19.4 months±2.9 (range, 15–26 months). The mean age was 58.4 years of age±10.1 (range 36–68 years). There were five (29.4%) male patients, and 12 (70.6%) female patients. The mean number of units of transfused packed red blood cells was 1.8 units (range 1–3 units; SD 0.7). All patients achieved union without the need for secondary procedures like bone grafting and the average time till union was 6.7 months (range from 4.5–9.5 months; SD 1.7 months). At the end of the follow-up the average range of forward flexion was 165.4º (range 150–177º; SD 8.2), and the average range of abduction was 166.2º (range 150–175º; SD 7.8). Patients’ average subjective satisfaction in the visual analogue scoring system was rated at 8.2 (range: 6–10; SD 1.3). At the end of the follow-up, the average Constant–Murley shoulder score was 88.1 (range 65–96; SD 7.6). The average Simple Shoulder Score was 77.9%±12.1% (range 50–92%). The mean University of California Los Angeles shoulder rating was 31 (range 24–34; SD 2.6). At the end of follow-up, the mean neck-shaft angle was 129.9° ±4.4° (range, 123–138°), and after surgery, it was 131.1° ±4.6° (range, 123–140°). Neck-shaft angle differences between the time of operation and follow-up were not statistically significant (P=0.7). One patient who had preoperative radial nerve palsy recovered from the palsy in 6.5 months. Another patient had preoperative axillary nerve palsy recovered within 2 months. No other patients had preoperative or postoperative neurological injury.
Conclusion
The double plating of the comminuted fractures of the proximal humerus with diaphyseal extension is safe and it does not add risk to either iatrogenic peripheral nerve injuries, humeral head vascularity, or shoulder impingement.