Abstract:

BACKGROUND: Non-locking anatomical plate is commonly used for open reduction and internal fixation for the treatment of four-part proximal humeral fracture, but it has the high probability of fracture re-displacement and humeral head necrosis after fixation.
OBJECTIVE: To observe the clinical results of proximal humeral locking plates fixation for the treatment of four-part proximal humeral fracture.
METHODS: Seventy-two patients with four-part proximal humeral fracture were included, 32 patients with dislocation of the humeral head and the other 40 patients without, and all patients were treated with open reduction and fixation with proximal humeral locking plates. Shoulder’s movement was restricted within 3 weeks after surgery, and then gradually began to perform the functional exercise. All patients were followed-up regularly and Neer scores were recorded to evaluate the function of shoulder after union of fractures.
RESULTS AND CONCLUSION: At the time of final followed-up, 6 patients were followed-up for 3 months, 13 patients were followed-up for 6 months, 31 patients for 9 months, 9 patients for 12 months, 8 patients for 18 months and 5 patients for at least 24 months. Fifty-three patients were followed-up for at least 9 months, the rate of fracture union was 98% (52/53), Neer scores with intermediate and above the intermediate level was 85% (45/53), humeral head osteonecrosis was 6% (3/53), and all the 3 patients were preoperative humeral head dislocation, subacromial impingement syndrome was 9% (5/53), and no screw loosing or fracture occured. There were no significant differences of Neer score and humeral head necrosis between patients with and without preoperative humeral head dislocation. The application of proximal humeral locking plate for the treatment of four-part proximal humeral fracture is helpful to the reduction of four-part fractured fragments and its fixation is stable. The recovery of postoperative shoulder functions is satisfactory and low rate of complications can be obtained following locking plate treatment of four-part fracture.