The outcome of proximal humeral locking plates in the management of three and four part proximal humeral fractures in special cohort of young patients in high velocity trauma

Background: Locking plate fixation provides satisfactory outcome following proximal humerus fractures. None of the previous studies selectively evaluate the outcome in young patients. This study evaluates outcome of locking plate system in the treatment of acute three- and four-part fractures in young patients. Methods: In this prospective study we included all patients who were less than 60 years, involved in high velocity trauma, had proximal humerus comminuted three part and four part fractures and were operated using locking plate at our centre, between August 2011 to August 2015. All the patients were followed up regularly. Assessment was done clinically using Constant and Murley scoring system and radiologically using signs of healing in the form of callus formation and cortical continuity. Results: Twenty-five eligible patients were operated during the study period. All patients were involved in motor vehicle collision. Average age of our patients was 41.2. The average duration of follow-up was 18.2 months(8 months to 27 months). 24 out of 25 fractures united clinically and radiologically at three months' follow-up. Average Constant and Murley score at final follow-up was 78.52. The results were excellent to good in 15 patients, fair in five patients and poor in five patients. Overall complication rate was 24%. Majority of them (20%) were restriction of movements of shoulders. None of our patients needed reoperation. Conclusion: Locking plate system, in three part and four part proximal humerus fractures in young patients, provides secure and stable fracture fixation for early mobilization. Early results with locking plate system were promising in younger patients. In these patients, locking plate system has definite role to preserve the humeral head and there by maintain the functional activity level.