Proximal humerus fractures (1.1 according to AO classification) represent 4–5% of all the fractures.

Generally they have been described as typical of the elderly patients; however, their frequency is now increasing in the young patients too, in which complex and severe fractures due to high energy trauma can be observed.

In this high-demanding patients open reduction and internal fixation with a plate can be considered as a first-choice treatment, in order to achieve anatomical reduction, stable fixation and early rehabilitation, in spite of some disadvantages (loss of reduction and secondary displacement due to insufficient angular and torsional stability, vascular damage, necrosis of the humeral head, impingement).

The rate of these complications can be reduced by using the new LP-PHP plate (Proximal Humeral Plate – Synthes Inc.) included in the LCP System.

LP-PHP plate (titanium alloy) is anatomical and characterized by low profile (2 mm. thickness) in order to reduce sub-achromial impingement. Its proximal portion is enlarged and shaped to adapt to humeral epiphysis and can be fixed only by means of locking head screws with different angulations; the distal portion presents the typical LCP combi-holes (5–8) able to receive either locking head screws or conventional screws. These features assure high planar and torsional stability and respect of bone vascularization.

At the Orthopaedic Department of Genoa University and the Department of Emergency of San Martino General Hospital (Genoa) from April 2003 to June 2004 we implanted 20 LP-PHP plates in 20 patients (12 females and 8 males, mean age 47.5 years) because of proximal humeral fractures in 19 cases (1.1 A3, ten cases; 1.1 B1, six cases; 1.1 C1, three cases; according to AO classification) and non-union in one case.

We had no intra or peri-operative complications, no infection or secondary dislocation, the synthesis, evaluated intra operatively, was always stable and we achieved anatomical post operative reduction in all cases but the non-union (poor reduction)

All fractures, including non-union, healed in an average time of two months; all patients but one healed without pain, functional restriction or any other outcomes.

Eight patients reached an excellent functional recovery with complete ROM; two patients were free of pain but a slight functional defect left. The patient suffering from non-union healed with a restricted motion due to ex non usu muscles weakness.

From 1994 to 2004, the authors treated 17 patients (nine males and eight females) with Blount disease admitted to the Disabled Children’s Home in Naro Moru (Kenya). Age at intervention ranged from 2 to 16 years (mean 8). In sevencases, the deformity was unilateral and mean age was 8.9 years; in the remaining 10 the deformity was bilateral and mean age was 8.5 years. Tibial proximal metaphyseal corticotomy was performed in 13 cases, and it was associated with calf bone osteotomy in patients aged over 5 years. In eight cases, metaphyseal osteotomy was associated with bone graft from homolateral calf bone and synthesis with Kirschner wire or “staples”, in nine it was performed without bone graft, and in one with axial external fixation. Complications included the following: infection with common peroneal nerve paresis treated with antibiotic therapy and transposition of tibialis posterior to tibialis anterior (one case); relapse of deformity treated with a new osteotomy (one case); incomplete correction (two cases); and pseudoarthrosis with loss of correction treated with a new osteotomy, removal of the pseudoarthrosis area and axial external fixation (one case). Nine patients for a total of 15 tibias were followed up at 1–10 years (mean 5.2). Results were good in 10 cases, with aligned limb and stable knee, fair in three cases, with X-ray evidence of varus deformity < 15° and/or knee instability in orthostasis, and poor in two cases with deformity > 15°, knee instability, length discrepancy > 3 cm. Age at operation and consequent severity of joint deformity influenced the results. Good results were obtained mainly in patients with Blount disease degree 1–3, whereas poor results were obtained in most patients with epiphyseal deformity > degree 4.