Four-part fractures require replacement: Once is enough-opposes

Complex fractures of the proximal humerus present a challenge to the orthopedic surgeon. There is little agreement regarding the optimal treatment for these fractures because complications occur with each of the many treatment options available. With hardware failure, osteonecrosis, malunion, and nonunion of concern with primary fixation, many believe arthroplasty to be the treatment of choice for these complex fractures. Certainly, humeral head replacement remains an acceptable option for some fracture patterns. Increasingly, good outcomes are obtained for complex fractures with the use of a variety of fixation techniques, particularly with minimally invasive approaches.