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Objectives and questions: This investigation evaluated the mid-term clinical efficacy of PHILOS locking plate fixation supplemented with 3D-printed polylactide (PLA) constructs in a cohort of osteoporotic patients.

Material and methods: A retrospective longitudinal analysis was conducted on 62 female patients (age range: 54–78 years) who underwent surgical intervention for osteoporotic proximal humeral fractures between 2015 and 2020. The cohort comprised 52 cases of three-part fractures (Neer; AO/OTA 11-B) and 10 cases of four-part fractures (AO/OTA 11-C). Internal fixation was performed using the PHILOS system combined with 3D PLA augmentation. Clinical performance was quantitatively assessed via the Constant–Murley Shoulder Score (CMS) at 3, 6, 12, 24 and 36 months post-surgery.

Results: Longitudinal data demonstrated a progressive enhancement in CMS values, which reached 78.2, 82.1, and 87.2 at 6, 12, 24 and 36 months, respectively. Radiographic consolidation was uniformly achieved across the entire sample, with no instances of avascular necrosis of the humeral head reported. Adverse events were limited, involving one case of intra-articular screw migration, two superficial infections, and a single instance of secondary lesser tuberosity displacement (8–10 mm) identified at the 3-month follow-up.

Discussion and conclusions: The integration of 3D-printed polylactide implants within PHILOS plate osteosynthesis facilitates robust mid-term functional restoration while maintaining a favorable safety profile. With a success rate of 89.5% over a 36-month observation period, this technique represents a viable surgical strategy for managing complex humeral fractures in the osteoporotic population.