ED management for one-part fractures includes a sling, pain control and non-emergent orthopedic follow-up.  For other fractures, orthopedic consultation is appropriate.  For two-part fractures, management is typically percutaneous pinning. Three-part fractures are typically managed by open reduction and internal fixation.  Four-part fractures typically require hemiarthoplasty.

     Fractures of the anatomic neck (which is located proximal to the surgical neck) are at risk for avascular necrosis due to the distal-to-proximal vascular supply of the proximal humerus.  Therefore, these fractures should have close orthopedic follow-up regardless of the Neer classification.