title: Three- and four-part fractures have poorer function than one-part proximal humerus fractures.
abstract: BACKGROUND
  Locking plates have become a commonly used fixation device in the operative treatment of three- and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures.
  
  
  OBJECTIVE
  We compared functional scores, ROM, and radiographs in patients with one-part proximal humerus fractures treated nonoperatively to those in patients with displaced three- and four-part proximal humerus fractures treated with open reduction and internal fixation using locking plates.
  
  
  METHODS
  We retrospectively reviewed 142 patients with proximal humerus fractures treated with a standardized treatment algorithm over a 6-year period. Three- and four-part fractures were treated surgically while one-part fractures were treated nonoperatively. Functional scores, ROM, and radiographs were used to evaluate outcomes. American Shoulder and Elbow Surgeons and SF-36 scores were obtained at 12 months. Of the 142 patients, 101 (51 with three- or four-part fractures and 50 with one-part fractures) had a minimum followup of 12 months (average, 19 months; range, 12-64 months).
  
  
  RESULTS
  The fractures united in all patients. At 1 year, the patients with one-part fractures had better SF-36 physical and mental scores and American Shoulder and Elbow Surgeons scores than the three- and four-part fractures. Both groups had similar shoulder ROM. Nine patients treated operatively had complications, four of which were related to screw penetration into the joint.
  
  
  CONCLUSIONS
  Patients with three- and four-part fractures should be advised of the likelihood of persistent functional impairment and a relatively higher risk of complications when treated operatively with locked plates.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E 17th Street, New York, NY 10003, USA.
authors.forename: Crispin
authors.initials: C
authors.lastname: Ong
authors.forename: Christopher
authors.initials: C
authors.lastname: Bechtel
authors.forename: Michael
authors.initials: M
authors.lastname: Walsh
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Zuckerman
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome