Early Experience of Managing Proximal Humerus Fractures with the S3 Plate

Background Fractures of the proximal humerus contribute a large number of admissions to our unit each year both for operative and conservative treatment. They can be a cause of great morbidity in many of these patients. Open reduction and internal fixation of fractures is performed in those patients who have displaced fractures and who are significantly independent to warrant surgical management. Methods This is a retrospective study evaluating the early experiences of a new type of plate fixation, the S3 plate (DePuy, Warsaw, IN, USA), in patients with displaced three- and four-part fractures. The case notes of those patients with more than 1 year of follow-up following fixation of their humeral fracture with a S3 plate were retrospectively reviewed. Each patient was also sent an Oxford Shoulder Score in the post for completion. Fifty-three patients were identified for inclusion in the study from 2007 onwards. Patients with a two-part fracture (n = 10) were excluded from the study because it was felt that these patients represented a group in whom conservative management was often the more commonly used treatment modality. Results Mean age was 54.1 years (range 21 years to 76 years); the male to female ratio was 1 : 2.4; and there were 25 three-part fractures and 17 four-part fractures. Time to discharge ranged from 4 months to 16 months, with a mean of 6.7 months. There were no intra-operative complications, one superficial wound infection and only one patient required further surgery. At 1 year, we have seen a low complication rate with good return to activity. Conclusions The implant has a very low revision rate and union was seen in most fractures by 6 months. The present study was limited by documented union time, numbers and differing discharge protocols. This new plating technique appears to offer a decreased complication rate compared to other plating systems without compromising patient outcomes.