Treatment of three- and four-part fractures of the proximal humerus with a modified cloverleaf plate

Twenty-six patients, ranging in age from 19 to 62 years (average 55), were evaluated an average of 6 years and 2 months (range 1-12 years) after open reduction and internal fixation of a three- or four-part fracture of the proximal humerus using a modified cloverleaf plate. Six patients had an associated dislocation of the humeral head. All fractures healed. No avascular necrosis of the humeral head was observed at follow-up. Twenty-two patients had an excellent result, two a good result, and two a fair result. The modified cloverleaf plate proved to be an excellent method for the treatment of proximal humerus fractures. Open reduction and internal fixation of three- and four-part fractures of the proximal humerus should be considered as initial treatment by an experienced surgeon, oven before use of a prosthetic replacement, which is recommended only for elderly patients with osteopenia.