Background Proximal humeral fractures, particularly in osteoporotic patients, remain an unsolved problem as regards the durability of the osteosynthesis. The AO/ASIF group has developed a new technique which aims to preserve the biological integrity of the humeral head and secures the reduction using multiple locking screws with angular stability (Philos), thus allowing an early mobilization.Patients and outcome We retrospectively reviewed the complications and functional outcome after a minimum follow-up of 1 year in 72 patients treated with this new method. 2 fractures failed to unite, and 3 patients developed an avascular necrosis of the humeral head. In addition, 2 implant failures were observed due to a technical error. According to the Constant score, the functional outcome was acceptable even in elderly patients.Interpretation The Philos method appears to be safe and can be recommended for the treatment of proximal humeral fractures in patients with poor bone quality.

One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.

Results after the operative treatment of 41 severe proximal fractures of the humerus are reported. The fractures were classified according to Neer (1970a). The aim of treatment was accurate reduction and stable fixation of the fracture with screws or with screws and a plate. When scored according to Neer's (1970a) functional assessment, results in the 31 patients re-examined more than 1 year postoperatively were excellent or satisfactory in 23 patients. Results were excellent or satisfactory in 14/15 patients with type III fractures, in 7/11 with IV, and 2/4 with type VI. In the only re-examined patient with a type V fracture the result was unsatisfactory. The most common technical error was a too high positioning of the AO plate and persistent varus deformation of the head of the humerus. High positioning of the plate caused post-operative restriction in the movements of the glenohumeral joint because the implant impinged under the acromion during abduction. No aseptic necrosis of the humeral head was observed. Of the patients of working age all but one returned to their preoperative occupations within a mean of 3.5 months after surgery.

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