Outcomes of Proximal Humeral Fracture Fixation Using Minimally Invasive Plate Osteosynthesis: A Prospective Clinical and Radiographic Study.

Introduction: Proximal humeral fractures are increasingly common due to both high-energy trauma in younger individuals and low-energy falls in the elderly. Surgical management is indicated for displaced and unstable fractures, with locking plates widely used. However, conventional open reduction techniques may compromise soft tissues and vascular supply. Minimally invasive plate osteosynthesis (MIPO) offers an alternative that preserves soft-tissue integrity while enabling stable fixation. Objective: This study aimed to evaluate the clinical and radiological outcomes of proximal humeral fractures treated with MIPO. Materials and Methods: This prospective study was conducted at Manipal Hospitals, Bengaluru, between August 2021 and May 2023. A total of 45 skeletally mature patients with proximal humerus fractures (classified according to Neer's system) underwent MIPO. Patients were followed up for 6 months, and outcomes were assessed using the Constant-Murley score and radiographic parameters, including union time, head-shaft angle, and complications. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25, with statistical significance set at P < 0.05. Results: Among the 45 patients, 53% were male and 47% female, with a mean age of 54.38 years. The most common fracture type was Neer's 3-part (64%). The average surgery duration was 40.5 min, and the mean blood loss was 114 mL. Fracture union was achieved in 96% of cases by 12 weeks, and the average Constant-Murley score was 77.2 ± 12.9. Functional outcomes were excellent or good in 78% of patients. Statistically significant associations were observed between outcomes and patient age (P = 0.00008) and comorbidities (P = 0.0002). The complication rate was 11%, including stiffness (7%), non-union (2%), and varus collapse (2%). Discussion: The findings indicate that MIPO is an effective and reliable technique for treating proximal humeral fractures, offering favorable functional recovery and high union rates with minimal complications. Better outcomes were associated with younger age, fewer comorbidities, and timely surgical intervention. Compared to open techniques, MIPO reduced operative trauma and preserved the vascularity of fracture fragments. Conclusion: MIPO provides promising clinical and radiographic outcomes in proximal humeral fractures, with a high rate of union and satisfactory functional recovery. It represents a safe and effective surgical option in appropriately selected patients, especially when combined with early rehabilitation and patient-specific care strategies.