Proximal Humerus Fracture

A 55-year-old man with severe osteoporosis (T-score −3.2) sustains a fall from standing height and presents with a proximal humerus fracture. Imaging reveals a 4-part fracture with severe comminution of the surgical neck and both tuberosities, with an intact articular surface. There is no neurovascular compromise. The patient is medically fit for surgery. What is the most appropriate surgical management?

A 68-year-old woman presents to the emergency department following a fall on her outstretched right hand while descending stairs at home. She reports severe right shoulder pain and inability to move her arm. On examination, there is marked swelling, ecchymosis over the shoulder, and the arm is held in adduction. X-rays reveal a displaced 3-part proximal humerus fracture with angulation of the surgical neck fragment. Which of the following is the most appropriate initial management?