Secure fixation of displaced proximal fractures of the humerus is a challenging problem. A total of 32 patients with acutely displaced three- or four-part proximal fractures of the humerus were treated by open reduction and internal fixation using the proximal humeral internal locking system (PHILOS) plate. There were 23 women and nine men with a mean age of 59.9 years (18 to 87). Data were collected prospectively and the outcomes were assessed using the Constant score. The mean follow-up was for 11 months (3 to 24). In 31 patients (97%) the fracture united clinically and radiologically at a mean of 10 weeks (8 to 24). The mean Constant score at final review was 66.5 (30 to 92). There was no significant difference in outcome when comparing patients aged more than 60 years (18 patients) with those aged less than 60 years (14 patients) (t-test, p = 0.8443). There was one case each of nonunion, malunion and a broken screw in the elderly population. This plate provides an alternative method of fixation for fractures of the proximal humerus. It provides a stable fixation in young patients with good-quality bone sufficient to permit early mobilisation. Failure of the screws to maintain fixation in the elderly remains a problem.

Uch injuries with a titanium radial head prosthesis, repair of torn collateral ligaments, and early mobilization of the elbow....

Fracture is one of the commonest bone problems occurring as a result of injury in normal bone or as a consequence of bone weakening. It leads to morbidity and mortality in the young and old in particular in relation to hip fractures and is an important public health issue. Fracture healing is a continuous process that can be divided into three partially overlapping phases: inflammation, repair and remodelling. The success of the repair phase depends on mechanical conditions in the fracture healing zone and the outcome of fracture healing depends on various patient and fracture factors. An understanding of the complex physiological processes involved in bone healing is essential to enable fracture treatment by allowing the practitioner to create the optimal conditions for repair of the bone and to avoid potential complications. This review focuses on the physiology of fracture healing and the main factors affecting it.