Plate fixation of proximal humeral fractures with indirect reduction: surgical technique and results utilizing three shoulder scores

To determine the outcome after indirect reduction and buttress plate fixati on of displaced and unstable proximal humeral fractures: we retrospectively evaluated 98 patients, an average of 34 months (range 24-72 months) after fracture fixation. The patients were reviewed and results were evaluated cl inically according to the Neer, UCLA and Constant score. A radiographic eva luation of fracture healing, avascular necrosis and degenerative changes of the shoulder joint was performed in all patients. Any complications of tre atment were assessed. Results were, according to the UCLA-rating system, go od to excellent in 76% of fractures. According to the Constant-score and th e Neer score, good to excellent results were obtained in 69 and 59% of frac tures, respectively. Poor results were mainly due to secondary malunion. Th e avascular necrosis rate was 4%. Non-union was seen in one case. Secondary varus deformity and retroversion of the humeral head as a result of lack o f rotational and angular stability of the plate developed in twelve (12%) a nd eight (8%) cases, respectively. Plate fixation is an adequate procedure for treating unstable and displaced two- to four-part fractures of the prox imal humerus, enabling early functional after-treatment. The incidence of a vascular necrosis and nonunion are low, when fracture reduction is performe d indirectly. Poor rotational and angular instability can lead to a loss of reduction. (C) 1999 Elsevier Science Ltd. All rights reserved.