Four-part proximal humerus fractures: evaluation and treatment.

Four-part proximal humerus fractures represent a difficult entity in the management of upper extremity trauma. Most of these fractures are not amenable to operative fixation; thus, surgical address is necessarily one of fracture arthroplasty. Timely reestablishment of the Gothic arch using a fracture-specific prosthesis leads reliably to anatomic tuberosity osteosynthesis. Hence, shoulder arthroplasty for fracture should be considered an augmented osteosynthesis, with precise prosthetic implantation supplementing anatomic tuberosity reconstruction. Further investigations are ongoing regarding the use of specific fracture implants and biologic substrates in an attempt to improve further the rate of tuberosity healing in the older patient population after this operation.