Extra-articular distal-third humeral shaft fractures are difficult to treat because stable fixation must be achieved while minimizing soft-tissue injury and the risk of nerve damage. Posterior double plating is a commonly used technique but requires extensive surgical exposure and routine handling of the radial and ulnar nerves. Anterior reversed proximal humeral locking plate system (PHILOS) fixation has emerged as a potential alternative that may provide adequate stability with less soft-tissue disruption.

This randomized controlled trial compares anterior reversed PHILOS plating with conventional posterior double plating in adult patients with extra-articular distal-third humeral shaft fractures. The study evaluates functional outcome using the Mayo Elbow Performance Score (MEPS) as primary outcome. Sexondary outcomes include: fracture union, operative parameters, range of motion, and complications including nerve injury, infection, and postoperative stiffness.

Inclusion Criteria:

1. Adults aged 18 years or older.
2. Acute extra-articular distal humeral shaft fracture.
3. AO/OTA type 12-A (simple) or 12-B (wedge) fracture.
4. Closed fracture.
5. Isolated injury.
6. Presentation within 14 days of injury.
7. Ability to provide informed consent and comply with follow-up.

Exclusion Criteria:

1. Open fractures.
2. Pathological fractures.
3. Previous surgery on the ipsilateral humerus.
4. Polytrauma requiring staged fixation.
5. Contraindication to general anesthesia.
6. Inability to complete the required follow-up period.

Outcome assessment was performed by independent orthopedic surgeons who were blinded to treatment allocation. Radiological and functional outcomes were evaluated without knowledge of the intervention group.