Orthopaedic Surgery Department, Marina Baixa Hospital, Villajoyosa, SPAIN

Purpose: Treatment of displaced fractures of the proximal humerus is a challenging problem. Different surgical techniques have been reported in the literature. This prospective study was undertaken to evaluate the results of a locking plate system in the treatment of displaced fractures of the proximal humerus.

Material and Methods: Between 2004 and 2006 30 healthy patients with acute displaced two to four-part fractures underwent open reduction and internal fixation with a locking plate system (Philos, Synthes Sp.). Their mean age was 53 (25 to 73), 13 patients were aged more, and 17 less than 60 years.. There were five 2-part (17%), sixteen 3-part (53%) and nine 4-part fractures (30%). Two patients presented an associated glenohumeral dislocation. Patients were reviewed at a mean follow-up of 24 months (12 to 47). The outcome were assessed using the Constant and DASH scores. Paired Student's t-test with 95% confidence intervals was used, and statistical significance was set at P< 0.05.

Results: At the end of follow-up Constant Score was 79.5± 8 and DASH Score was 23.0± .9. Constant and Dash sores in patients aged more than 60 years were 80± 9 and 27± 21.6 and in group aged less than 60 years 78± 10 and 20.1± 7.4 respectively, . This differences were not statistically significant (P>0.05). The Constant and DASH scores of two- three- and four-part fractures showed no significant differences (P>0.05). Complications including failure of ostheosynthesis (1), avascular necrosis (3) and infection (1) were seen in 5 patients (11%). Re-operation was necessary in two patients (4.6%).

Conclusion: This study suggests that treatment with the locking compression plate may give a satisfactory outcome in patients with displaced fractures of the proximal humerus. Clinical outcome showed no differences when age an type of fracture were studied. Longer follow-up of our patients is required to assess whether late osteonecrosis and/or degenerative develops.