Although most proximal humerus fractures can be treated nonoperatively, 4-part fractures and 3-part fractures/dislocations in elderly patients often require management with prosthetic arthroplasty. Reverse arthroplasty is gaining in popularity, but hemiarthroplasty still has a role in the management of 4-part and some 3-part fractures and dislocations. The 2 most important technical factors influencing functional outcome in hemiarthroplasty patients are the restoration of the patient’s correct humeral head height and version, and healing of the greater and lesser tuberosities in an anatomic position. Hemiarthroplasty for proximal humerus fracture provides predictable pain relief, but functional recovery is much less predictable.
Key points
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The majority of proximal humerus fractures can be managed non operatively.
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Four part fractures and 3 part fracture/dislocations in elderly patients often require management with prosthetic arthroplasty.
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While reverse shoulder arthroplasty is gaining popularity for the management of fractures in patients over the age of 70, hemiarthroplasty remains a valuable tool in the management of these fractures.
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Restoration of the patients’ correct humeral head height and version and healing of the greater and lesser tuberosities in an anatomic position are crucial for regaining function after this procedure.