With the continuous progress of domestic aging, the occurrence of proximal humeral fractures is second only to distal radius fractures and hip fractures, ranking third with an incidence of approximately 4%-5%. The first choice for the treatment of patients with Neer type III or IV proximal humeral fractures is the locking plate technique. With the increasing number of proximal humerus fractures in recent years, the postoperative complications of locking plate technique alone have been increasingly concerned. Relevant studies in recent years have found that the poor quality of proximal humerus and the loss of medial column are the main reasons for postoperative complications. In this study, a buttress plate was placed on the inner side of the proximal humerus to enhance the overall stability and firmness of proximal humerus and reduce postoperative complications.

To observe and compare the clinical efficacy of the simple lateral PHILOS plate and the lateral PHILOS plate combined with the medial buttress plate in the treatment of Neer type Ⅲ proximal humeral fractures.

From January 2015 to January 2020, 65 patients with Neer type Ⅲ proximal humeral fractures were admitted into our department. Among them, 32 cases were treated with lateral PHILOS plate, and the other 33 cases were treated with PHILOS plate combined with medial buttress plate. The operation time, intraoperative blood loss, fracture healing time, humeral neck shaft angle in the 12th month after operation, Neer score and Constant score in the 6th and 12th months after operation were compared between the two groups.

No neurovascular injury occurred in the two groups of patients during the operation, and the wounds healed at first stage. All patients were followed up for 12 months. The operation time, intraoperative blood loss, and fracture healing time of the double-plate group were significantly longer than those of the single-plate group (P<0.01) . The Neer score and Constant score of the double-plate group in the 6th and 12th months after surgery were significantly higher than those of the single-plate group (P<0.01) . At the last follow-up in the 12th month after surgery, the humeral neck shaft angle of the double-plate group was closer to the normal angle than that of the single-plate group (P<0.01) .

For patients with Neer type Ⅲ proximal humeral fractures combined with medial column injury, treatment with lateral PHILOS plate combined with medial buttress plate can improve the medial stability and overall firmness of proximal humerus, and reduce the incidence of reduction loss, humeral head varus, fixation failure, etc, which is helpful for early shoulder rehabilitation and shoulder function restoration.