A 45-year-old man falls on his outstretched hand and sustains a displaced proximal humeral fracture. The Neer classification divides the proximal humerus into 4 parts. A 4-part fracture in an elderly patient is best treated by:

• A Closed reduction and collar-and-cuff immobilisation
• B Reverse total shoulder arthroplasty (rTSA) ✓
• C Open reduction and internal fixation with a locking plate
• D Intramedullary nailing of the humerus

Explanation

Neer 4-part fractures in elderly patients (>70 years) carry a very high risk of AVN of the humeral head (up to 80%) and poor outcomes with ORIF due to osteoporotic bone and complex anatomy. Reverse total shoulder arthroplasty, which relies on deltoid function rather than intact rotator cuff, provides reliable pain relief and functional restoration in elderly patients even with rotator cuff compromise. ORIF with locking plates is preferred in younger patients (<60 years) with good bone quality. Hemiarthroplasty is an older alternative but yields unpredictable outcomes.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.