The treatment of humeral fractures in old patients is still an orthopedic problem. Different surgical schools suggest different treatments for head-preserving procedures. Because of new implants and functionally disappointing results in primary hemiarthroplasty, the indication for hemiarthroplasty was examined more critically. The decision of which procedure to choose is complicated by the lack of proper studies with comparable fracture types and enough cases regarding the specific problems of operative fracture treatment in the elderly. Correctly, besides range of movement, the number of necessary reoperations, length of time until pain reduction, and earliest possible axial weight-bearing of the injured limb should influence the therapeutic decision. Regarding all these topics, primary hemiarthroplasty in old patients and specific fracture situations is still to be recommended.
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