Trauma · Shoulder

Proximal humerus ORIF

Locking plate, screw, or intramedullary nail fixation of a shoulder-area humerus fracture in displaced patterns.

Overview

Shoulder joint anatomy showing the humeral head, glenoid socket, and rotator cuff muscles (supraspinatus and infraspinatus).
Shoulder anatomy. The shoulder is a shallow ball-and-socket joint. The top of the upper-arm bone (humerus) sits against a small dish on the shoulder blade (glenoid), and four rotator-cuff tendons wrap around the ball to hold it centered during every arm motion.
Wikimedia Commons · CC BY-SA 4.0

The proximal humerus is the top of the upper-arm bone that forms the ball of the shoulder. Most proximal humerus fractures are minimally displaced and heal well with a sling and early motion. Surgery is considered for displaced, angulated, or unstable patterns, particularly in younger active patients.

For severely comminuted fractures in elderly patients, reverse shoulder replacement is often chosen over fixation because the rotator cuff is frequently also compromised.

Why it's done

Proximal humerus ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:

  1. Displaced surgical-neck fracture

    Significant angulation or displacement affecting shoulder mechanics.

  2. Displaced tuberosity fragments

    Rotator cuff pull displaces these fragments away from the bone.

  3. Three- or four-part fractures in active patients

    Fixation aims to preserve the native joint.

  4. Head-splitting fracture

    Reconstruction or arthroplasty is typically required.

How it works

Through a deltopectoral approach on the front of the shoulder, the fracture is reduced and a pre-contoured proximal humerus locking plate is applied. Screws into the humeral head capture the articular fragment without penetrating the joint surface. Heavy sutures through the plate secure the rotator cuff tendon attachments.

Intramedullary nailing through the top of the shoulder is an alternative for certain patterns and is placed under fluoroscopic guidance.

Recovery

The arm is protected in a sling with pendulum and passive range-of-motion exercises starting early. Active assisted motion begins at four to six weeks and active motion at six to eight weeks. Strengthening is delayed until three months. Stiffness and avascular necrosis of the humeral head are the most common complications. Most patients regain functional motion by six months.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.

Further Reading

External patient-education references and related OSI pages for additional background: