Fletcher JWA, et al. - Using an established and validated finite element osteosynthesis test kit, researchers investigated how variations in screw configuration influence the predicted failure risk of PHILOS plate fixation for unstable proximal humerus fractures. They created malreduced unstable 3-part fractures via performing osteotomy on 26 low-density humerus models. PHILOS plates were used to virtually fix the fractures. They simulated 12 screw configurations: 6 using 2 screw rows, 4 using 3 rows, and 1 with either 8 or 9 screws. Outcomes revealed the significant influence of screw configurations on predicted cutout failure risk for locking plate fixations of unstable proximal humerus fractures in low-density bone. Although clinical corroboration is required, results suggest a reduction in peri-screw strains with additional screws, support maximization of the distance between them whenever possible and using the calcar screws.