C2.2 fractures (anatomic neck fractures with marked varus malalignment) often have an associated fracture involving one or both tuberosities.
This fracture needs to be properly reduced in order to achieve good results in terms of stability, function and pain relieve. In particular, the varus displacement needs to be corrected in order to prevent secondarily increased varus collapse or implant failure. In contrast to the C1-type 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.