C2.1 fractures (impacted anatomic neck fractures with marked valgus malalignment) often have an associated displaced greater tuberosity fracture.
This fracture needs to be properly reduced to achieve good results in terms of stability, function and pain relief. In contrast to C1 fractures, C2-type fractures are generally more unstable after reduction (disimpaction), especially if the medial hinge is disrupted.
Operative fixation is the preferred treatment. However, the decision for surgery should also include the functional demands of the patients, the presence of comorbidities, and the ability to undergo operative treatment.
Indications for hemiarthroplasty are inability to achieve stable fixation, especially in elderly patients with osteoporotic bone.