2 part fracture of the upper end of humerus	After open reduction and internal fixation
Final appearance and function

Neer classified these fractures according to number of parts i.e. two, three, or four part fractures. The humeral head receives its blood supply through the greater and the lesser tuberosity hence more the number of displaced fragments, more severe the injury, more the risk to the blood supply of the head of the humerus. If the blood supply is damaged, the fracture may go into delayed or non union. The head may undergo avascular necrosis leading to a painful shoulder joint.

Special Views

A true A.P.view of the shoulder should be taken with tube tilted 30 laterally and true lateral view is trans scapular view. An axillary view is important to know the direction of the dislocation of the head of the humerus.

Management

Consists of surgery for displaced fractures, which can hardly be brought back to normal with closed manipulation. Surgery consists of open reduction and internal fixation according to the principles of A.O.using K wires, wire loops, buttress plates. In badly displaced four part fractures where the viability of the head is doubtful, many centres perform primary hemireplacement using Neer's prosthesis to replace upper end of the humerus.

Complications

Avascular necrosis of the head of the humerus leading to arthrosis, painful, restricted range of shoulder movements due to injury to the rotator cuff and shoulder hand syndrome due to reflex sympathetic dystrophy are some of the complications.