Can we decipher indications and outcomes of the PHILOS plate for fractures of the proximal humerus?

摘要

I read with interest the recent article by Zhou et al. [1] describing the outcome of the proximal humeral internal locking system (PHILOS) plate in 74 patients. However, I am still unsure of the exact indications for the plate. Despite the escalation in the use and publications regarding the outcome of the PHILOS plate, the evidence as to whether this device is beneficial to patients it was designed for remains difficult to decipher. There have been 27 studies of the 63 cited on PubMed that have used the Constant score as their outcome assessment tool (Table 1). There is, however, marked heterogeneity between these studies, with mean age ranging from 42 to 78 years and reported cohort size ranging from nine to 294 fractures. It is interesting to note the epidemiology of proximal humeral fractures where the mean age is 65 years [2], with three- and four-part fractures occurring in older patients [3].