Fixed-angle locking plating of displaced proximal humerus fractures.

Proximal humerus fractures are common, especially among patients older than 60 years who have osteoporosis. Several techniques have been used within the past several decades to treat displaced proximal humerus fractures. Many different implants have been investigated and tested, all with inadequate results; debate continues as to the best method of fixation. Fixed-angle locking plates offer a relatively new treatment option for these complicated fractures, especially in patients with osteoporosis. The use of locking plates for treating comminuted proximal humerus fractures has biologic and biomechanical advantages over conventional fixation techniques. Complications including varus fracture collapse and screw penetration of the articular surface nonetheless remain problematic. Although the locking plate technique provides exceptional fixation stability, its use must be tailored to the individual patient, taking into account the extent of trauma, the fracture characteristics, and the patient's age and expectations; therefore, it must be carefully weighed against other forms of treatment. Prospective clinical trials and further study are necessary to generate data comparing locking plate fixation and alternative surgical treatments.