A 60-year-old woman falls on her outstretched hand. X-ray shows a Neer Type IV proximal humerus fracture (4-part fracture with head impacted). The preferred definitive treatment in this patient is:
- A Conservative management with collar and cuff
- B Open reduction and internal fixation with locking plate
- C Hemiarthroplasty (shoulder replacement) ✓
- D Percutaneous pinning
Correct answer: C. Hemiarthroplasty (shoulder replacement)
Explanation
Neer 4-part fractures in elderly patients carry a very high risk of avascular necrosis of the humeral head (50–75%) because both the arcuate artery (from anterior circumflex humeral artery) and the posterior circumflex supply are disrupted. Hemiarthroplasty provides reliable pain relief and function in older, lower-demand patients. ORIF with locking plate may be preferred in younger, high-demand patients but carries AVN risk. Conservative management is inadequate for displaced 4-part fractures. Percutaneous pinning is indicated only in minimally displaced or 2-part fractures.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.