OPEN REDUCTION AND INTERNAL-FIXATION OF 3-PART AND 4-PART FRACTURES OF THE PROXIMAL HUMERUS

Thirty-one patients, ranging in age from 19 to 62 years (average, 55 y ears), were evaluated an average of six years seven months (range, one to 12 Sears) after open reduction and internal fixation of a three- o r four-part fracture of the proximal humerus. Six patients had an asso ciated dislocation of the humeral head. A modified cloverleaf plate wa s used in 26 cases and an AO T-plate in five cases. All fractures heal ed. No avascular necrosis of the humeral head was observed at follow-u p examination. Twenty-three patients had an excellent result, two had a good result, and six had a fair result. Open reduction and internal fixation of three- and four-part fractures of the proximal humerus are indicated as initial treatment, even before the use of a prosthetic r eplacement, which should be recommended only for elderly patients with osteoporotic bones.