In this series, open repair with use of a locked plate resulted in better outcome scores than did hemiarthroplasty in similar patients, especially in those with a three-part fracture, despite a higher overall complication rate. Open reduction and internal fixation of fractures with an initial varus extension pattern should be approached with caution.

Neer 3- and 4-part proximal humeral fractures in older patients with initial varus angulation of the humeral head had a significantly worse clinical outcome and higher complication rate than similar fracture patterns with initial valgus angulation. Two factors had significant influence on final outcome in these fracture patterns: initial direction of the humeral head angulation and length of the intact metaphyseal segment attached to the articular fragment. The best clinical outcomes were obtained in valgus impacted fractures with a metaphyseal segment length of greater than 2 mm, and this was independent of Neer fracture type. Humeral head angulation had the greatest effect on final outcomes (P < 0.001), whereas metaphyseal segment length of less than 2 mm was predictive of developing avascular necrosis (P < 0.001).

Thirty-six tibial plateau fractures in 35 patients were treated with the less invasive stabilisation system (LISS). Patients' mean age was 42 years. There were 27 type C fractures and nine type B fractures according to AO/ OTA classification. The average time to healing was 4.2 months (3-7 months). Deep infection developed in two cases. One patient healed in 6°of varus, and seven patients had an increased articular angulation of 6°(4-8°) in the sagittal plane. There were no cases of loss of reduction, non-union, or deep vein thrombosis. The LISS system could be considered for the management of tibial plateau fractures.

This report identifies the changing trends in clinical practice in the treatment of geriatric femoral neck fractures in the U.S. Treating physicians should be aware of these trends, which include a decreasing national incidence of geriatric femoral neck fractures as well as an increase in the use of THA.