الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Proximal humeral fractures account for around 5% of all fractures in the elderly population. Typically, they affect patients older than 60 years of age. Women represent around 75% of all presented cases and fractures are often associated with osteoporosis. It is the third most common fracture pattern seen in the elderly. Mechanism of injury is bimodal as low-energy falls cause PHF in elderly patients with osteoporotic bone while high-energy trauma describes the fracture in young individuals. The fracture is frequently associated with concomitant soft tissue and neurovascular injuries. The goal of treatment for the elderly population with proximal humeral fractures is to maintain patient independence in daily living by achieving a painless shoulder with an adequate function. Most proximal humeral fractures are either displaced or minimally displaced, and could be adequately treated by non-operative measures.
Displaced three and four part proximal humeral fractures always require surgical treatment. Controversy remains here about the optimal surgical management. A wide variety of treatment modalities have been described, varying from minimal percutaneous fixation to prosthetic replacement of the humeral head, besides a certain consensus regarding prosthetic treatment of “head-split” fractures. The choice of surgical treatment is based on surgeon preference and experience with treatment options. Currently most comminuted proximal humeral fractures are being treated with the utilization of hemi shoulder prosthesis, alternatively an open reduction and internal fixation (ORIF) using locking plates have been used as a sound mean of operative fixation.
Bespoke designed prostheses have been developed for treatment of dislocated three and four part proximal humeral fractures. Special emphasis is highlighted by many authors on the importance of re-fixation and healing of the tuberosities. Moreover, there are no level I randomized studies that compare surgical treatment of displaced three part and four-part fractures of the proximal humerus using Hemiarthroplasty with surgical treatment using locking plates. Consequently, there is no consensus on which treatment leads to better functional results: surgical treatment performing hemi-Arthroplasty or humeral head treatment with a locking plate. A randomized prospective clinical trial was designed to compare hemi-arthroplasty with locking plates for the treatment of three- and four-part fractures of the proximal humerus in a population.