Fixed-angle locked plating of two-, three-, and four-part proximal humerus fractures.

Proximal humerus fractures are relatively common, accounting for 5% to 9% of all fractures.1-3 These fractures can pose a challenge for the treating orthopaedist because of the generally osteoporotic nature of bone in the elderly and the relative deforming forces of the surrounding muscles. Fractures are classified according to the Neer criteria, and treatment is often guided by the relative displacement of the anatomic fragments. Nondisplaced fractures have historically been treated conservatively, with generally good outcomes.4 Displaced fractures with angulation of the articular surface >45° and displacement of the major segments >1 cm have been treated surgically, as have fractures with substantial valgus impaction, all with mixed results.5-23 Surgical techniques have included percutaneous fixation, standard plate-and-screw fixation, intramedullary fixation with rods or pins, the use of tension bands with and without plates or rods, standard plate modification into blade plate constructs, and hemiarthroplasty.4-23 Many of these alternative open techniques were developed because of the high failure rates noted initially with standard plating. The inherent difficulties with internal fixation have led several authors to recommend hemiarthroplasty for the treatment of most threeand four-part humerus fractures.5,9,19,24,25 However, locked plates allow for more secure fixation in compromised bone, thereby possibly leading to reduced incidence of failure of internal fixation. Newer plates also incorporate suture eyelets that further enhance the fixation construct and resist deforming muscular forces. Additional investigation is necessary, but early results with locked plate fixation for the treatment of proximal humerus fractures have been encouraging. It is anticipated that this technique will provide another potentially viable alternative to prosthetic replacement for the treatment of these difficult injuries.