General considerations

C1.3 fractures (isolated anatomic neck fractures of the proximal humerus) are rare and carry a risk of avascular necrosis.

Operative fixation is the preferred treatment. The choice of fixation depends on the surgeon’s experience and skill, available implants, and equipment. However, the functional demands of the patients, the presence of comorbidities and the ability to undergo nonoperative treatment should also be taken into considerations. The decision for surgery should also include the functional demands of the patients, the presence of comorbidities and the ability to undergo operative treatment. Nonoperative treatment tends to have unsatisfactory results.

Primary or delayed hemiarthroplasty can be considered for elderly osteoporotic patients, for whom fixation would not be stable, or after the development of avascular necrosis (AVN).