Two-Part Fractures and Fracture Dislocations

Proximal humeral fractures are common and are usually osteopenic or osteoporotic and about 85% occur in patients older than 50. Two-part fractures account for approximately 28% of proximal humeral fractures, with most being surgical neck fractures. This article discusses the management of two-part fractures and analyzes the use of nonoperative treatment, conventional plating, locked plating, antegrade intramedullary nailing, retrograde pinning, and Kirschner wires in their treatment. The literature indicates that nonoperative treatment is as effective as conventional plating, antegrade nailing, and Kirschner wiring in treating two-part surgical neck fractures in older patients. The early results of locked plating may be better, but more studies are required to prove this. This article gives the results of nonoperative treatment of all types of two-part fractures and fracture dislocations.