title: Assessment and management of three-and four-part proximal humeral fractures.
abstract: Three-and four-part comminuted fractures of the proximal humerus are difficult and technically demanding to treat. The various treatment methods reported in the literature are reviewed. It is recommended that three-part fractures be treated with open reduction and internal fixation. Four-part fractures in the younger, active patient also can be treated successfully with open reduction and internal fixation. However, in the elderly and in the patient with osteoporosis, a hemiarthroplasty 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.
authors.affiliation: Department of Orthopaedics, Northampton General Hospital, England.
authors.forename: J
authors.initials: J
authors.lastname: Rees
authors.forename: J
authors.initials: J
authors.lastname: Hicks
authors.forename: W
authors.initials: W
authors.lastname: Ribbans
mesh_terms: D000367:Age Factors; D001158:Arteries / Q000033:anatomy & histology; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D018460:Fractures, Comminuted / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D006811:Humerus / Q000098:blood supply; D015994:Incidence; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications; D011859:Radiography