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Surgical neck with translation or multifragmentary: Reduction and preliminary fixation

Reduction

Attempt to reduce these fractures with distal traction on the arm. In transverse  fractures with translation, proper placement of the shaft against the proximal fragment may be stable. An oblique or fragmentary fracture is usually unstable.

Care should be taken to restore the medial calcar. To gain more stability slight impaction of the humeral shaft into the humeral head might be considered.
If there is medial fragmentation, special attention must be paid to prevent varus malalignment.