Rigid internal fixation of fractures of the proximal humerus in older patients

In 42 elderly patients, 33 women and nine men with a mean age of 72 years, we treated displaced fractures of the proximal humerus (34 three-part, 8 fo ur-part) using a blade plate and a standard deltopectoral approach, Functio nal treatment was started immediately after surgery. We reviewed 41 patient s at one year and 38 at final follow-up at 3.4 years (2.4 to 4.5), At the final review, all the fractures had healed. The clinical results wer e graded as excellent in 13 patients, good in 17, fair in seven, and poor i n one. The median Constant score was 73 +/- 18, Avascular necrosis of the h umeral head occurred in two patients (5%), We conclude that rigid fixation of displaced fractures of the proximal hume rus with a blade plate in the elderly patient provides sufficient primary s tability to allow early functional treatment. The incidence of avascular ne crosis and nonunion was low, Restoration of the anatomy and biomechanics ma y contribute to a good functional outcome when compared with alternative me thods of fixation or conservative treatment. Regardless of the age of the p atients, we advocate primary open reduction and rigid internal fixation of three- and four-part fractures of the proximal humerus.