Proximal humerus fracture fixation is an operation to realign and stabilise a broken upper end of the arm bone (humerus) near the shoulder, using a locking plate or intramedullary nail. It is performed for displaced fractures that cannot be managed in a sling.
For plate fixation: an incision is made over the front or side of the shoulder. The fracture fragments (including the greater and lesser tuberosities) are reduced and fixed with a contoured locking plate and screws. For nailing: a shorter incision allows insertion of a nail through the top of the humeral head into the canal. Sutures may be used to secure the tuberosity fragments. The operation takes one to two hours.
Surgery is recommended for significantly displaced proximal humerus fractures (3- and 4-part fractures), fracture-dislocations, and in younger patients where anatomical restoration is important. In elderly patients with very comminuted fractures, hemiarthroplasty or reverse shoulder replacement may be preferred.
Many proximal humerus fractures (up to 80%) can be managed in a sling with early physiotherapy. Non-operative treatment is appropriate for undisplaced or minimally displaced fractures and for frail elderly patients.
CT scan for fracture classification and planning. Surgery within one to two weeks of injury.
Anatomical restoration of the proximal humerus allowing earlier rehabilitation. Outcomes depend heavily on fracture pattern, bone quality, and patient age.
Very common. Intensive physiotherapy is essential.
Screws may penetrate into the joint as osteoporotic bone settles.
The plate may impinge under the acromion.
Loss of blood supply to the humeral head, particularly with 4-part fractures. Risk 10-30%.
Failure to heal or healing in a poor position.
Weakness of deltoid muscle. Usually temporary.
Wound or deep infection.
Plate or screw breakage.
General anaesthesia with nerve block. Beach-chair or lateral position.
Sling for two to four weeks. Pendular exercises begin within the first week. Active movement from four to six weeks depending on fixation stability. Strengthening from eight to twelve weeks. Full recovery six to twelve months. Some permanent loss of overhead reach is common.
X-rays at two weeks, six weeks, and three months.
For elderly patients with severely comminuted fractures and poor bone quality, hemiarthroplasty or reverse shoulder replacement may give more predictable results. Your surgeon will recommend the best option for your specific fracture.
Some loss of overhead reach is common after proximal humerus fractures, regardless of treatment. Most patients achieve a functional range sufficient for daily activities.