General considerations

A3 fractures (displaced surgical neck fractures) are unstable. They typically occur in older patients. These fractures almost all heal with nonoperative management, and most have satisfactory function, even with deformity. Treatment aims to achieve adequate stability with an acceptable reduction. Outcome is usually not improved by surgical fracture fixation, in spite of deformity. Thus, surgical treatment should be reserved for open fractures, exceptional deformity, or failure of nonoperative care.

If operative reduction and fixation are chosen, the technique will depend upon surgical skill, available implants and equipment. Fixation without open reduction may be attempted initially, but the surgeon should be prepared to do an open reduction if the attempt is unsuccessful.

If fixation is chosen in A3.3 fractures, nailing or angular stable plates might be preferable because they offer more stable fixation in a short or osteoporotic proximal humeral segment.