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Internal Fixation of Displaced Proximal Humeral Fractures with Two One-Third Tubular Plates

Wanner, Guido A. MD; Wanner-Schmid, Elisabeth MD; Romero, José MD; Hersche, Otmar MD; von Smekal, Alexander MD; Trentz, Otmar MD; Ertel, Wolfgang MD, FACS

The Journal of Trauma: Injury, Infection, and Critical Care: March 2003 - Volume 54 - Issue 3 - p 536-544
doi: 10.1097/01.TA.0000052365.96538.42

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 ≥ 60 years) and fracture type had no influence on functional outcome.

Conclusion  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.

From the Division of Trauma Surgery (G.A.W., E.W.-S., O.T., W.E.) and Department of Orthopaedic Surgery (J.R.), Balgrist, and Department of Diagnostic Radiology (A.V.), University of Zurich, Zurich, and Orthopaedic Surgery, Sonnenhof Hospital (O.H.), Bern, Switzerland.

Submitted for publication April 3, 2001.

Accepted for publication November 20, 2002.

Address for correspondence: Wolfgang Ertel, MD, FACS, Benjamin Franklin Medical Center, Department of Trauma/Reconstructive Surgery, Trauma Center Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany; email:

© 2003 Lippincott Williams & Wilkins, Inc.