Proximal humerus fractures ac- count for approximately 4% to 5% of all fractures. Three- and four-part proximal humerus fractures and fracture-dislocations are among the most severe and account for only 5% of all proximal humerus fractures.

Fracture patterns vary based on the mechanism of injury and bone density at the time of injury. In older patients (aged >60 years), three- and four-part proximal humerus fractures are usually the result of low- energy trauma. These fractures are often considered fragility fractures, and they serve as a clinical indication of existing osteopenia or osteoporosis.

When warranted, the patient should be evaluated and treated for osteoporosis as part of fracture management. In younger patients, proximal humerus fractures can be the result of high-energy trauma.

Greater consideration is given to humeral head preservation with fracture osteosynthesis in this patient population.