Al-Azhar International Medical Journal /Al-Azhar International Medical Journal · Mar 25, 2026

Internal Fixation by PHILOS Plates Versus Non-Operative Treatment for Proximal Humerus Fracture in Elderly Patients (Comparative Study)

By EL-Bahrawy AW, Akar AI, Elzahed E

Background: Fractures affecting different portions of the upper humerus, known as proximal humeral fractures (PHFs), account for around 5% of all fractures and rank third in frequency among older individuals. Aim: To compare outcomes of PHFs in elderly patients treated with PHILOS plate fixation versus non-operative management following low-energy trauma. Patients and Methods: For 40 senior patients with proximal humeral fractures, this prospective randomized trial at Al-Azhar University hospitals (June 2024–June 2025) compares conservative arm immobilization to PHILOS plate fixation. Twenty patients were part of Group I who had non-operative treatment (arm immobilization). Group II, who had surgical fixation. Results: Based on the findings, several recommendations can be made for clinical practice and future research. PHILOS plating should be considered the preferred option for active patients or those with functional demands requiring early return to activity, given its superior outcomes in range of motion, pain relief, and faster recovery. Non-operative management remains appropriate in elderly, low-demand patients with significant comorbidities, where surgical risks and costs may outweigh the benefits. Conclusion: This study demonstrates that while both non-operative management and PHILOS plating can achieve satisfactory outcomes in proximal humerus fractures, surgical fixation provides superior functional recovery, faster pain resolution, earlier union, and quicker return to daily activity.

doi.org/10.21608/aimj.2026.424964.2930 Open access Interventions