A 58-year-old male patient sustains a high-energy proximal humerus fracture. When considering open reduction and internal fixation for this patient, which of the following findings would be an indication for synthetic or allograft supplementation of the proximal humerus metaphysis?
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- Loss of medial calcar support and severe comminution A metaphyseal or intramedullary device may be necessary to restore stability of the medial calcar
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- Initial displacement of the greater tuberosity Sutures in the rotator cuff are recommended for tuberosity fixation but do not require supplementation of the proximal humerus metaphysis
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- Concomitant ipsilateral glenoid fracture Supplementation is typically required for medial calcar comminution
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- Ipsilateral femur fracture Supplementation is typically required to support the medical calcar when there is comminution