Early experience with the PlantTan Fixator Plate for 2 and 3 part fractures of the proximal humerus

This study reports the early results for clinical and radiological outcome of fixation of completely displaced or grossly angulated (>90 degrees ) 2 and 3 part fractures of the proximal humerus using the PlantTan Fixator Plate (Medizentechnik, Aachen, Germany). Using a deltopectoral approach the humeral head articular fragment was reduced onto the humeral shaft and fixed with the implant, tuberosity fragments were held with transosseous sutures. Early passive, progressing to active, physiotherapy was instituted from the first postoperative day. No other fixation or bone graft was used. In 15 patients, with 16 injured shoulders and an average age of 63 years the mean follow up was 17 months. As a percentage of the normal side the Constant-Murley score for those patients retaining the implant was mean 74% (range 36%-100%). There were six shoulders with score >80% (Good), four shoulders with score between 60 and 79% (Satisfactory) and four shoulders <60% (Poor). Four shoulders (all in patients over the age of 70 years), developed avascular necrosis. Of these, one patient underwent shoulder replacement hemiarthroplasty and one patient underwent removal of the implant. We have demonstrated functional outcome similar to other modes of internal fixation in patients under 70 years. It cannot be recommended for elderly patients (over 70 years) as it is associated with a high incidence of avascular necrosis and fixation failure.