Fractures of proximal humerus account for nearly 5% of all fractures. Majority of these fractures are minimally displaced and can be treated non-operatively with good functional results. However, treatment of unstable, displaced and comminuted fractures remains a challenge and optimal treatment continues to be controversial.

This study was undertaken to evaluate the results of proximal humeral internal locking system (PHILOS) plating done for treatment of displaced three- and four-part fractures of the proximal humerus.

Between November 2003 and February 2008, a total of 36 patients with displaced three- and four-part fractures of the proximal humerus had an open reduction and internal fixation using a PHILOS plate.

Data was collected retrospectively and clinical and radiological outcomes were assessed.

The mean follow up was 18 months. 35 (97.2%) united clinically and radiologically, with a mean neck/shaft angle of 127.1 degrees. One patient (2.8%) had revision procedure for implant failure, with a longer PHILOS plate and bone graft. The mean time to union was 9 weeks (7 to 20). The mean Constant score at final review was 72.1 (36 to 96). A total of 16 patients (44.4%) had excellent outcome, 16 (44.4%) had satisfactory outcome, but in four (11.2%) the outcome was poor.

The PHILOS plate provides good fracture stability early-on allowing early mobilisation without compromising fracture union. It requires minimal soft tissue dissection, does not need contouring and angular screw fixation gives good stability. We stress the importance of minimal soft tissue dissection to preserve the vascularity of the head, indirect methods of reduction and early mobilization.

We describe the results of 287 intra-articular fractures of the calcaneum in 247 patients treated by minimally-invasive reduction and K-wire fixation between 1994 and 2003. There were 210 men (85%) and 37 women (15%). The most common cause of injury was a fall from a height in 237 patients (96%). Fracture classification was based on the method described by Sanders and Essex-Lopresti. All patients were operated on within 21 days of injury and 89% (220) within 48 hours. The reduction was graded as nearly anatomical (less than 2 mm residual articular displacement and satisfactory overall alignment) in 212 (73.9%) fractures.

There were 20 cases (7%) of superficial pin-track infection and five (1.7%) of deep infection. All healed at a mean of 6 weeks (3 to 19). Loss of reduction was observed in 13 fractures (4.5%) and a musculocutaneous flap was needed in three (1%).

The results were evaluated in 176 patients (205 fractures) with a mean age of 44.3 years (13 to 67), available for follow-up at a mean of 43.4 months (25 to 87) using the Creighton-Nebraska Health Foundation Assessment score. The mean score was 83.9 points (63 to 100). There were 29 (16.5%) excellent, 98 (55.7%) good, 26 (14.8%) fair and 23 (13%) poor results. A total of 130 patients (73.9%) were able to return to their original occupation at a mean of 5.6 months (3.2 to 12.5) after the injury.

Semi-open reduction and percutaneous fixation is an effective treatment for displaced intra-articular fractures of the calcaneum.