ASSESSMENT AND MANAGEMENT OF 3-PART AND 4-PART PROXIMAL HUMERAL FRACTURES

Three- and four-part comminuted fractures of the proximal humerus are difficult and technically demanding to treat. The various treatment me thods reported in the literature are reviewed. It is recommended that three-part fractures be treated with open reduction and internal fixat ion. Four-part fractures in the younger active patient also can he tre ated successfully with open reduction and internal fixation. However, in the elderly and in the patient with osteoporosis, a hemiarthroplast y is the treatment of choice, There is a need for universal agreement on a scoring system for measuring outcome in these fractures to allow a meaningful comparison between reported treatment methods.