Purpose of the Study: We evaluated the complications of proximal humeral fractures, which are treated with locked plates.

Materials and Methods: 103 patients (70 female, 33 male) with proximal humeral fractures with an average follow-up time of 19 months (2 weeks– 43 months) and an average 62,1 (21–90) years of age are treated with open reduction and internal fixation from September 2005 to April 2009 in our clinic. Internal fixation was performed with PHILOS plate in 93 patients and S3 Humeral plate in 10 patients. Early and late complications that are encountered during the follow-up time is presented.

Results: Complications occurred in 10 patients (7 females, 3 males) with an average age of 67,1 (41–89) years from which 5 of them had varus inclination, 5 had inter-joint screw penetration, 1 had fixation failure, 1 had breakage of the implant and 1 had infection. Complication rate (10 of the 103 patients) was 9.7%. The rates of varus inclination (5 of the 103 patients) and the rates of screw penetration (5 out of 103) were both 4.85%. During the follow-up time 3 of the 5 patients with varus inclination (60%) had progression (displacement of varus). 4 of the 5 patients with varus inclination (80%) had screw penetration. All of the 4 patients (100%) with varus displacement had screw penetration. The average Constant Murley shoulder score of the complication group were 67.8 (50–90).

Conclusion: Surgical treatment of the proximal humeral fractures has a high rate of complications. Screw penetration rates of the patients with varus inclination is 60%. Accurate indication, protection of the head’s inclination angle with an appropriate surgical approach and a proper technique, fine calculation of the screw lengths are needed for a successful functional result. In our study, where we have found fewer rates of complications than the literature, we have pointed out the reasons of the complications and we have stated the noteworthy precautions to lower the rates of these

Proximal humeral fractures are common fractures that may lead to severe functional disability. In open reduction and internal fixation of these fractures deltopectoral approach is pereferred by many surgeons being an internervous plane and because of familiarity. However when this aprroach is used extensive soft tissue dissection is inevitable and control of the commonly displaced tuberculum majus fragment which is displaced posterolateraly is difficult. In this prospective study we compared deltopectoral and lateral deltoid splitting approach by using the same fixation material.

Between October 2005 and March 2007 42 patients were included in the study group. In Group A a lateral deltoid split approch and in Group B deltopectoral approach was used. Group A consisted of 22 cases; mean age 60.95 (26–90 years old); 12 female and 10 male, Group B 20 cases; mean age 56.9 (24–86 years old); 13 female, 7 male. Philos locking plate fixation (Synthes) was used in every case. When deltoid split approach was used axillary nerve was explored and protected, a C-arm was used in every case. Functional results and compications were compared at the follow up visits.

When radiological results were compared the reduction of head and tubercular fragments were better in deltoid splitting approach. The Constant score was better in Group A at an earlier time period 68.9 vs 58.4 (p< 0.01). At the 6th month follow up the difference between Constant scores was not significant, 85.9 vs 85.2 (p> 0.05). Axillary nerve lesion due to lateral deltoid split exposure was not observed in any of the cases.

Lateral deltoid split exposure with identification and protection of the axillary nerve facilitates 270 degrees control of the head and tubercular fragments in AO/ASIF type B and C fractures. Additional fixation of tubercular fragments by sutures passed through cuff tendons and fixed to the plate helps to maintain the reduction. Compared to double incision minimal invasive approach a shother plate is used without any inadvertant risk to the axillary nerve. Better Constant scores are achieved at an earlier time. We recommend this technique in AO/ASIF type B and C fractures.

Displaced proximal humeral fractures are common fractures with high complication rate especially in osteoporotic elderly population. The purpose of our clinical prospective case series was to evaluate the Philos locking plate developed by AO/ASIF in surgical treatment of these difficult fractures.

Between October 2005 and March 2007 42 patients were included in the study group. The patients were divided in two groups based on the age at the time of presentation. Group A consisted of patients younger than 65 years old; 14 male, 9 female; mean age 43.8 (24–63 years old) and group B were patients above the age 65; 16 female, 3 male; mean age 77.3(66–90 years old). All fractures were classified according to AO/ASIF classification and radilogical and functional outcomes were assesed.

Mean follow up was 7.8 months. The mean Constant scres were 86.3(71–92) in group A and 84.7(68–92) in group B (p> 0.05). All fracture healed uneventfully and no implant failure was observed. Displacement of tuberculum majus fragment was observed in only one case. Avascular necrosis of the humeral was not observed in any case.

This prospective study proved that when technical details are followed and supplementary suture fixation of the tubercular fragments to the plate is obtained locking plate fixation of these problem fractures in every age group has a very high radiological and functional success rate. Especially in fixation of osteoporotic fractures lack of fixation failure and initiation of early range of motion is a major advantage.