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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.

Original publication




Journal article


Clin orthop relat res

Publication Date



18 - 29


Age Factors, Arteries, Female, Fracture Fixation, Fractures, Comminuted, Humans, Humeral Fractures, Humerus, Incidence, Male, Postoperative Care, Postoperative Complications, Radiography