In the Neer classification of proximal humeral fractures, a 4-part fracture with displacement of the head fragment is best treated by:

• A Hemiarthroplasty (shoulder replacement) ✓
• B Open reduction internal fixation with locking plate
• C Non-operative sling immobilisation
• D Percutaneous pinning

Explanation

Neer 4-part displaced proximal humeral fractures in elderly patients carry a >90% risk of avascular necrosis of the humeral head because all blood supply (anterior circumflex, posterior circumflex humeral arteries) is disrupted. Hemiarthroplasty (or reverse shoulder arthroplasty in rotator cuff-deficient patients) provides reliable pain relief and function. ORIF with locking plates can be considered in younger patients with good bone quality. Closed/percutaneous methods are insufficient for 4-part displaced fractures.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.