Three-part proximal humerus fractures are severe injuries that represent a technical challenge. Evaluation of fracture displacement is the cornerstone in determining a surgical indication. Treatment selection for three-part proximal humerus fractures includes nonoperative treatment, closed reduction and percutaneous pinning, open reduction internal fixation, and hemiarthroplasty. Decision-making is based on fracture pattern, patient age, bone quality, degree of comminution, and existing comorbidities. Recent efforts at closed reduction or limited open reduction and minimal osteosynthesis are encouraging in the treatment of three-part proximal humerus fractures. The technique of closed reduction and percutaneous pinning is difficult and demanding, and careful attention must be paid to the technical considerations and the appropriate indications. Multiple treatment options must be available at the time of surgery and the surgeon should pursue the method that will facilitate anatomic fracture reduction and stability.
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