title: Internal fixation of displaced proximal humeral fractures with two one-third tubular plates.
abstract: BACKGROUND
  Operative treatment of displaced proximal humeral fractures often results in poor functional outcome. We report a technique that provides improved rotational stability of the fracture and thus allows early functional treatment.
  
  
  METHODS
  Seventy-one consecutive patients (67 +/- 18 years) with displaced fractures of the proximal humerus (two-part, n = 10; three-part, n = 41; four-part, n = 20) were treated by open reduction and internal fixation using two one-third tubular plates on the anterior and lateral aspects of the proximal humerus. Passive motion was started on the third postoperative day, followed by actively assisted exercises on day 6.
  
  
  RESULTS
  Seven patients (12%) had complications (fracture redisplacement, avascular necrosis of the humeral head, frozen shoulder, subacromial impingement, and implant loosening) that required further surgical intervention. Sixty patients (85%) were available for follow-up evaluation 17 +/- 10 months after the injury. Using the Constant score, 34% of the patients had very good results, 29% had good results, 25% had fair results, and 12% had poor results. Age (< 60 years or > or = 60 years) and fracture type had no influence on functional outcome.
  
  
  CONCLUSIONS
  These results demonstrate the high stability of internal fixation with two one-third tubular plates that allowed early mobilization of the shoulder in all patients and emphasize this technique as a preferred treatment option for displaced fractures of the proximal humerus.
authors.affiliation: Division of Trauma Surgery, University of Zurich, Switzerland.
authors.forename: Guido A
authors.initials: GA
authors.lastname: Wanner
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wanner-Schmid
authors.forename: José
authors.initials: J
authors.lastname: Romero
authors.forename: Otmar
authors.initials: O
authors.lastname: Hersche
authors.forename: Alexander
authors.initials: A
authors.lastname: von Smekal
authors.forename: Otmar
authors.initials: O
authors.lastname: Trentz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ertel
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D012784:Shoulder Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*