Review Article | Journal of Clinical Orthopaedics | Vol 10 | Issue 2 | July-December 2025 | page: 56-60 | Sachin Kale, Gaurav Kanade, Arvind Vatkar, Ashok Ghodke, Abhilash Srivastava, Ojasv Gehlot, Atul Yadav

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.776

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 09 Jul 2025, Review Date: 02 Aug 2025, Accepted Date: 16 Sep 2025 & Published Date: 10 Dec 2025

Author: Sachin Kale [1], Gaurav Kanade [1], Arvind Vatkar [1], Ashok Ghodke [1], Abhilash Srivastava [1], Ojasv Gehlot [1], Atul Yadav [2]

[1] Department of Orthopaedics, Dr. D Y Patil School of Medicine, Nerul, Navi Mumbai, Maharashtra, India
[2] Department of Orthopaedics, D Y Patil Hospital School of Medicine, Resident In Orthopaedic Department, Navi Mumbai, India.

Address of Correspondence

Dr. Sachin Kale,
Department of Orthopaedics, Dr D Y Patil School of Medicine, Nerul, Navi Mumbai, Maharashtra, India.
E-mail: sachinkale@gmail.com

Abstract

Proximal humerus fractures remain a challenging entity, especially in elderly patients with osteoporotic bone or in multifragmented fracture patterns. The proximal humeral internal locking system (PHILOS) system continues to be a reliable fixation method, but reported failure rates may reach 30–40% when biomechanical principles or biological preservation are compromised. Common causes of failure include loss of medial buttress, improper screw placement, varus malreduction, vascular compromise, and poor implant choice in unsuitable bone stock.
This review highlights evidence based techniques to minimize failure, including restoration of medial support, optimized calcar screw placement, tuberosity fixation with sutures, selective use of augmentation in osteoporotic bone, and biological-friendly surgical approaches. Attention to these principles can substantially improve outcomes, reduce complications, and prevent failure of fixation.
Keywords: Proximal humerus fracture, Proximal humeral internal locking system plate, Fixation failure, Medial buttress, Calcar screw, Osteoporotic bone, Arthroplasty alternatives

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