The difficult proximal humerus fracture: tips and techniques to avoid complications and improve results.

The indications and techniques for surgical management of fractures of the proximal humerus remain controversial, and the results of treatment are often disappointing, with a relatively high complication rate. Anatomic reduction can be difficult, and loss of fixation because of poor bone quality may lead to fracture displacement and malunion. Hemiarthroplasty has a high rate of shoulder stiffness, tuberosity resorption, and glenohumeral instability. There is a wide variety of surgical techniques and implants to treat these fractures, but there is little guidance in the literature on specific indications for their use. Therefore, it is important for orthopaedic surgeons to be familiar with techniques to avoid complications and improve results when treating proximal humerus fractures.