الفهرس 
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Abstract
Acute proximal humerus fractures are the third most common fracture in elderly patients, accounting for 5% of all fractures. Although many of these fractures are not treated with arthroplasty, displacement is sometimes too great for closed treatment, and open reduction and internal fixation is contraindicated due to a high risk of fixation loss, malunion, nonunion, or avascular necrosis.(107)
Proximal humeral fractures are classified with the four segment classification by Neer, which is still the most commonly used classification system. Treatment is essentially based on this classification. Theoretically, in three and four-part fractures, the blood supply of the humeral head can be jeopardised, which may result in avascular necrosis of the humeral head resulting in a loss of function.(2)
Hemiarthroplasty has traditionally been the treatment of choice, advocated as the gold standard by Neer in patients with complex 3- and 4-part fractures with poor bone stock not amenable to reconstruction. However, the results of hemiarthroplasty for fracture in the literature are unpredictable, depending largely on the fate of the tuberosities. The frequency of tuberosity nonunion, malunion(39%-50%), and implant proximal migration has been confirmed in multiple studies. This leads to a high incidence of poor results, with a surgical complication rate of 50%, 10% reoperation rate, and up to 62% dissatisfaction rate. Pain relief is often acceptable, but functional outcomes frequently vary.