The two-part proximal humeral fracture: a review of operative treatment using two techniques.

A review of 45 patients who have undergone surgery for two-part fractures of the proximal humerus (Neer Group III) is reported using two operative techniques, AO plating and intramedullary Rush pins. Good functional results were obtained using the former technique in seven out of eight of the patients under the age of 50 years who mainly sustained their original injury as a result of high-energy motor vehicle accidents. However, in the more common low-energy, osteoporotic fracture in the elderly population, results were unsatisfactory in 12 out of 14 cases where AO plating was used, usually as a result of fixation failure. The Rush pin technique produced more reliable results in this age group, with satisfactory functional scores being obtained in 16 out of 23 patients. It is suggested that the Rush pin technique is preferable to plate fixation in the more common osteoporotic insufficiency fracture in the elderly.