Functional outcome of locked-plate fixation of displaced three-part and four-part fractures of the proximal humerus

Abstract

BackgroundThe treatment of multifragmentary proximal humerus fractures with conventional plate fixation has been associated with implant failure due to lack of bone support. In contrast, limited internal fixation techniques may not allow early rehabilitation because of poor stability. Locked-plate fixation ensures stable fixation of unstable fractures as they rely on the fixed angle between the screws and the plate, thereby facilitating early rehabilitation.Aim of the studyThe aim of this study was to evaluate the results of open reduction and internal fixation of displaced three-part and four-part proximal humerus fractures with locked plate and early mobilization.Patients and methodsThis study included cases of 24 patients (18 female patients and six male patients) who had three-part and four-part proximal humeral fractures treated surgically with open reduction and locked-plate fixation. Their ages ranged from 21 to 63 years (average 45.4 years). The postoperative management included early shoulder mobilization.ResultsNineteen fractures (79%) healed in good anatomical position, three healed with varus malunion, and two developed avascular necrosis of the humeral head. At the end of the follow-up period, the mean Constant-Murley score was 66.5. The results were excellent or good in 17 patients (71%), fair in five patients (21%), and poor in two patients (8%). The mean DASH score was 28.3. Nine complications (37.5%) were seen during the follow-up period. Complications included avascular necrosis of the humeral head in two patients (8%), varus malunion of the humeral head in three patients (12.5%), and subacromial impingement in four patients (16.7%). Subacromial impingement was mainly caused by the superior plate position. Reoperation was required in five patients (21%).ConclusionProximal humeral locked-plate fixation provides sufficient fracture stabilization in the treatment of unstable proximal humeral fractures; however, the complications are frequent, and careful surgical technique is required to ensure satisfactory results.