Decision making in difficult proximal humerus fractures: When to fix, pin, or replace

Management of displaced proximal humerus fractures remains a debated topic in orthopaedic surgery. Many different management techniques have been advocated from open reduction and internal fixation (ORIF), to percutaneous techniques, to hemiarthroplasty. The author's technique for determination of viability of the articular segment is reviewed, as are the special cases of the valgus-impacted four part fracture and three part fractures. The indications for percutaneous fixation, ORIF, and hemiarthroplasty are reviewed.