Most fractures in the proximal humerus occur in osteoporotic bones. Various fixation methods are used to mainly circumvent this osteoporotic bone fixation. The superior approach through deltoid split gives good exposure for ORIF. Anterior delto-pectoral groove exposure is also used extensively.

Neer classification: His fundamental grouping was done by the number of fragments and their displacement. These are head, shaft, greater tuberosity, and lesser tuberosity.

Indications for surgery include displaced two part or three part fractures which are unstable, three part anatomic neck fractures, classic four part fractures.

Below are the various options of surgical treatments .

ORIF, Percutaneous pinning or screwing, Hemi arthoplasty

 

Bibliography:

 

J Am Acad Orthop Surg 2008;16:294-302