Do 3 or 4 part fractures always need surgery?

Usually: True three and four part proximal humerus fractures usually require repair or replacement for the shoulder to function correctly. Patients have to be in good medical condition, and be able to tolerate the surgery. They have to be motivated in rehabilitation, and can expect 6 months to a year or more to get maximum recovery.

Occasionally not: In the very elderly or medically frail or low activity patient there may be indications to not perform surgery on these fractures.