Open reduction and internal fixation of three- and four-part fractures of ³

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the proximal humerus. Esser RD. Clinical Orthopaedics & Related Research. (299):244-51, 1994 Feb. Thirty-one patients, ranging in age from 19 to 62 years (average, 55 Â years), were evaluated an average of six years seven months (range, one to 12 years) after open reduction and internal fixation of a three- or four-part fracture of the proximal humerus. Six patients had an associated dislocation of the humeral head. A modified cloverleaf plate was used in 26 cases and an AO T-plate in five cases. All fractures healed. No avascular necrosis of the humeral head was observed at follow-up examination. Twenty-three patients had an excellent result, two had a good result, and six had a fair result. Open reduction and internal fixation of three- and four-part fractures of the proximal humerus are indicated as initial treatment, even before the use of a prosthetic replacement, which should be recommended only for elderly patients with osteoporotic bones. *