ORIF of three- and four-part proximal humeral fractures: a retrospective study of long-term clinical and complication outcomes of two-plate fixation methods

Abstract Background The aim of this study was to compare clinical outcomes and complication rates during long-term follow-up (≥ 6 years) after treatment for three- and four-part proximal humeral fractures using two different types of locking plates. Materials and methods A total of 113 patients with three- and four-part proximal humeral fractures who underwent surgery between September 2012 and January 2019 were enrolled retrospectively. Data for 49 patients [ 9 males, 40 females; mean age [standard deviation] (SD ) 68.9 (5.8) years} treated with a PGR (intrauma) plate (group A) and 51 patients [10 males, 41 females; mean age (SD): 66.0 (7.5) years] treated with a PHILOS humeral plate (PHP, group B) were available at the last follow-up. The mean follow-up periods in groups A and B were 10.8 and 10.2 years, respectively, with a minimum follow-up of 6 years. At the final follow-up evaluation, functional outcomes were assessed using the Oxford Shoulder Scale (OSS), Simple Shoulder Test (SST), and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. X-ray evaluation was also performed, and complications were recorded. Results The mean OSS score in the PGR and PHP groups at follow-up was 42.9 and 39.1, respectively ( p > 0.05). The SST score (PGR: 7.5 ± 2.0; PHP: 7.3 ± 4.0) and DASH score (PGR: 22.1 ± 5.5; PHP: 20.5 ± 4.0) were similar in both groups ( p > 0.05). In our series, 6% of patients had complications; these included avascular necrosis of the humeral head (two cases in the PGR group and three in the PHF group) and one case of periplate fracture in the PGR group. Conclusions Among patients with three- and four-part proximal humeral fractures, both PGR plate and PHP treatment achieved comparable functional outcomes and demonstrated similarly low complication profiles. These results reinforce the appropriate clinical utility of either implant for fixation in the treatment of this fracture pattern. Level of evidence: 3