title: Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus.
abstract: BACKGROUND
  Controversy persists concerning the preferred treatment of displaced fractures of the proximal part of the humerus. The present study was undertaken to evaluate the results of open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus and the functional limitations of patients in whom avascular necrosis of the humeral head develops as a complication of this fracture.
  
  
  METHODS
  We assessed the intermediate and long-term results for sixty patients with a three or four-part fracture of the proximal part of the humerus who had undergone open reduction and internal fixation with cerclage wires or a T-plate. The Constant score and a visual analog score for pain were calculated, and radiographs of the proximal part of the humerus were evaluated.
  
  
  RESULTS
  After an average of ten years of follow-up, fifty-two patients (87%) had a good or excellent result on the basis of the Constant score whereas eight patients (13%) had a poor result. Fifty-one patients (85%) were satisfied with the result at the time of the most recent examination. Twenty-two patients (37%) had development of avascular necrosis of the humeral head, and seventeen (77%) of these twenty-two patients had a good or excellent Constant score.
  
  
  CONCLUSIONS
  Open reduction and internal fixation with cerclage wires or a T-plate yields good functional results in most patients. This option should be considered even for patients with fracture-dislocation patterns that are associated with a high risk for avascular necrosis of the humeral head, as this complication did not preclude a good result.
authors.affiliation: Department of Orthopaedics, Academic Medical Center G4, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. ajwijgman@knmg.nl
authors.forename: A J
authors.initials: AJ
authors.lastname: Wijgman
authors.forename: W
authors.initials: W
authors.lastname: Roolker
authors.forename: T W
authors.initials: TW
authors.lastname: Patt
authors.forename: E L F B
authors.initials: EL
authors.lastname: Raaymakers
authors.forename: R K
authors.initials: RK
authors.lastname: Marti
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000209:etiology; D012784:Shoulder Fractures / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome