Open Reduction and Internal Fixation of Four-Part Proximal Humerus Fractures

Four-part fractures typically occur in elderly patients with poor bone quality and are often not amenable to osteosynthesis. Avascular necrosis with subsequent collapse is common (1,2).Moreover, the results of hemiarthroplasty in this patient population are better than the results of operative fracture stabilization (1,3). Therefore, the optimal treatment for most four-part proximal humerus fractures is prosthetic replacement.