Open reduction and internal fixation of three- and four-part fractures of the proximal humerus.

Thirty-one patients, ranging in age from 19 to 62 years (average, 55 years), were evaluated an average of six years seven months (range, one to 12 years) after open reduction and internal fixation of a three- or four-part fracture of the proximal humerus. Six patients had an associated dislocation of the humeral head. A modified cloverleaf plate was used in 26 cases and an AO T-plate in five cases. All fractures healed. No avascular necrosis of the humeral head was observed at follow-up 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 replacement, which should be recommended only for elderly patients with osteoporotic bones.