{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T22:49:03Z","timestamp":1769554143966,"version":"3.49.0"},"reference-count":29,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Complications after proximal humerus osteosynthesis are not uncommon. The aim of this study was to compare the outcomes of osteosynthesis using PHILOS with fresh-frozen femoral head allograft augmentation and without it, and to assess the influence of risk factors and their impact on the occurrence of postoperative complications. Methods: This retrospective study evaluates the radiological outcomes and complications of treating proximal humerus fractures (Neer III\u2013IV) in 116 patients over 50 years of age treated between 2017 and 2021. Results: Osteosynthesis without allograft was performed in 84 patients and with allograft in 32 patients. In total, 42 patients (36%) had a three-part fracture and 74 (64%) had a four-part fracture. The Deltoid Tuberosity Index was comparable between the groups (1.59 \u00b1 0.25 vs. 1.50 \u00b1 0.26; p = 0.802). The average duration of surgery was 101.3 \u00b1 21.3 min with allograft and 86.0 \u00b1 31.9 min without allograft (p = 0.004). AVN was verified in four patients (3.5%), head collapse in nine (8%), cut-out in six (5%), reoperation in eight (7%), infection in three (2.5%), and pseudoarthrosis in one (1%) case. Conclusions: An allograft augmentation improves construct stability, but cannot compensate for inadequate surgical technique. None of the risk factors significantly influenced the development of AVN and pseudoarthrosis. The greater tubercle comminution (p = 0.005), calcar loss (p = 0.020, p = 0.112), allograft augmentation (p &lt; 0.001), and medial hinge restoration (p = 0.012, p = 0.002) were significant risk factors associated with HC and screw cut-out, respectively. The greater tubercle redislocation was influenced by its comminution, calcar loss, and the use of allograft augmentation. HFZ and DTI had no significant impact on surgery results or complications.<\/jats:p>","DOI":"10.3390\/jcm15020910","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:21:40Z","timestamp":1769505700000},"page":"910","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiological Outcomes, Complications, and the Influence of Risk Factors in PHILOS Repair of Three- and Four-Part Proximal Humerus Fractures with and Without Femoral Head Allograft: Insights from a Cohort of 116 Patients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5688-7961","authenticated-orcid":false,"given":"Zoltan","family":"Cibula","sequence":"first","affiliation":[{"name":"Jessenius Faculty of Medicine in Martin, Comenius University Bratislava, 03659 Martin, Slovakia"},{"name":"Department of Orthopaedic Surgery, University Hospital Martin, Kollarova 2, 03659 Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2892-0687","authenticated-orcid":false,"given":"Milan","family":"Cipkala","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Hospital Martin, Kollarova 2, 03659 Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1981-8773","authenticated-orcid":false,"given":"Diaa","family":"Sammoudi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Hospital Martin, Kollarova 2, 03659 Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6712-3457","authenticated-orcid":false,"given":"Marian","family":"Grendar","sequence":"additional","affiliation":[{"name":"Jessenius Faculty of Medicine in Martin, Comenius University Bratislava, 03659 Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7278-0509","authenticated-orcid":false,"given":"Monika","family":"Cervencova","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Hospital Martin, Kollarova 2, 03659 Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1308\/rcsann.2022.0120","article-title":"Outcomes following reverse total shoulder arthroplasty vs. operative fixation for proximal humerus fractures: A systematic review and meta-analysis","volume":"106","author":"Heo","year":"2024","journal-title":"Ann. 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