The management of proximal humerus fractures remains a challenging task from diagnosis to treatment. Most proximal humerus fractures are minimally displaced and can be satisfactorily treated nonoperatively. In the significantly displaced fracture, a reproducible classification system is essential to make the correct diagnosis and to choose appropriate treatment modalities. Minimal internal fixation techniques have proved in recent years to be of great benefit in efforts to maximize results and minimize complications. Another therapeutic option, especially in older patients, is primary humeral head replacement. The surgical technique and design for prostheses have evolved since the first report by Neer in 1955. In spite of the impressive developments in surgical techniques and implants, controversies still remain when choosing treatment methods for severely displaced fractures. First, which techniques of internal fixation allow for anatomic reduction and stable fixation without increasing the complication rate? Second, when should open reduction and internal fixation be abandoned and primary humeral head replacement be undertaken? These questions are examined with a careful review of the recent literature. (C) 2000 Lippincott Williams and Wilkins, Inc.
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