Usually, a B2-type fracture can be advantageously treated by osteosynthesis. Quite often, the pathology is located on the medial metaphyseal side and the humeral head itself is not involved in the pathology. Therefore, the risk of avascular necrosis with humeral head collapse is low. Furthermore, depending on fracture level, fixation of the prosthesis is challenging, since its distal support is limited.

A hemiarthroplasty requires a repairable rotator cuff.

Supporting indications

  • Poor bone quality
  • Humeral head ischemia in the elderly patient
  • Intraoperative failure of osteosynthesis

Advantages

  • Provides a replacement for unreconstructable humeral head
  • If failure of fixation and/or avascular necrosis (AVN) are highly likely, primary arthroplasty may avoid a second surgery

Disadvantages

  • Resection of the humeral head
  • Possible failure of tuberosity repair
  • Possible pain and/or poor shoulder function
  • Possible arthroplasty failure