This operation involves fixing a broken upper arm bone (proximal humerus) near the shoulder joint using a metal plate and screws, or occasionally nails or wires. It is performed when the fracture is displaced or unstable and is unlikely to heal satisfactorily without surgical intervention.
An incision is made over the front or side of the shoulder. The fracture fragments are realigned into their correct position and held in place with a metal plate and screws, or sometimes an intramedullary nail. In some cases, particularly in older patients with poor bone quality, a shoulder replacement (hemiarthroplasty or reverse replacement) may be more appropriate than fixation. The operation typically takes one to two hours.
Surgery is recommended when the fracture is significantly displaced (the bone fragments have moved out of position), is in multiple parts, or involves the joint surface. Without surgery, these fractures may heal in a poor position, leading to ongoing pain, stiffness, and weakness.
Many proximal humeral fractures are minimally displaced and can be managed with a sling, pain relief, and gradual physiotherapy. Your surgeon will advise whether surgery is necessary based on the fracture pattern and displacement seen on X-rays and CT scans.
Fracture fixation is often performed within days of the injury once the necessary scans and pre-operative assessments are complete. Standard pre-assessment is performed. You should fast before surgery and inform the team about all medications.
The aim is to restore the alignment of the bone and allow earlier, more predictable rehabilitation. Successful fixation improves the likelihood of regaining good shoulder movement and function. However, outcomes vary depending on fracture severity, bone quality, and patient factors.
Very common after proximal humeral fractures regardless of treatment. Physiotherapy is essential.
Expected around the fracture site and may persist for several months.
The plate and screws may be felt under the skin and occasionally cause irritation.
Loss of blood supply to the humeral head, causing the bone to collapse. Risk depends on fracture pattern.
The bone may not heal, or may heal in a poor position. May require further surgery.
Screws may migrate into the joint, particularly in weakened bone. May require removal.
Wound infection or deep infection around the metalwork.
The axillary nerve is close to the surgical field. Injury is uncommon but can cause numbness or weakness.
Usually performed under general anaesthesia with a nerve block. The nerve block provides pain relief for up to 24 hours after surgery.
A sling is worn for two to six weeks depending on the fixation. Gentle exercises begin early under physiotherapy guidance. Active movement starts once the fracture is showing signs of healing, usually at four to six weeks. Full recovery takes three to six months or longer. Some loss of movement is common, particularly overhead reach.
Regular follow-up with X-rays at two weeks, six weeks, and three months to monitor fracture healing. Physiotherapy is a key component of recovery.
Not routinely. Plates are only removed if they cause irritation or other problems after the fracture has fully healed.
Some loss of movement is common after proximal humeral fractures, even with surgery. Physiotherapy helps maximise recovery, but overhead reach may remain somewhat limited.
Usually at around six to eight weeks, once you can comfortably control the steering wheel. This depends on your individual progress.