Four-Part Fractures Require Replacement: Once Is Enough—Affirms

The optimal treatment of four-part proximal humerus fractures is yet undetermined. Although recent advances in locked plate technology have led to increased interest in humeral head preservation, results are inconsistent and complication rates remain high. Hemiarthroplasty is a durable option for the management of these fractures, especially in patients with underlying osteopenia. With proper adherence to key surgical principles, hemiarthroplasty can predictably restore function and produce satisfactory results in a high percentage of patients. Because the academic literature has reliably demonstrated pain relief and consistent functional results, humeral head replacement should be considered as a primary management strategy for four-part proximal humerus fractures.