The operative treatment of proximal humeral fractures. Is the T-plate fixation still an adequate therapy?

No general agreement exists on the operative therapy of displaced proximal humeral fractures. The purpose of this study is to evaluate different inter nal fixation techniques (plate fixation, figure-of-eight tension wirering, lagscrew) and to verify if the plate fixation is still an adequate therapy in the treatment of displaced proximal humeral fractures. A followup invest igation was conducted in 51 patients after an average of 4.2 years. AT-plat e fixation was performed in 62.7 %, minimal invasive technique in 21.6 % an d a shoulder prosthesis in 15.7 % of these patients. At follow-up 60.7 % of the patients with a 3- or 4-part fracture had good or excellent results in the Constant score (59 % T-plate, 66 % minimal invasive). Humeral head nec rosis was seen in 15.9 % of the patients with a T-plate fixation and in 9.1 % of the patients with minimal invasive techniques. Based on our results a nd the reviewed literature we can confirm advantages of the minimal invasiv e techniques in the treatment of 4-part fractures. However, good results ca n be obtained with T-plate fixation in 2- or 3-part fractures especially in younger patients.