Proximal Humerus Fracture Fixation

Indications

Proximal Humeral Fractures, radiograph of a complex proximal humerus fracture
Radiograph of a complex proximal humerus fracture. Image by Article authors: Georg Mattiassich, Lucian Lior Marcovici, Rolf Michael Krifter, Reinhold Ortmaier, Peter Wegerer, Albert Kroepfl, Wikimedia Commons, CC BY 2.0.
  • Displaced two and three part fractures in good bone
  • Displaced greater tuberosity fractures
  • Fracture dislocations in younger patients
  • ProFHER (JAMA 2015) found no benefit from surgery for most displaced fractures in older adults
  • Reverse shoulder arthroplasty for complex fractures in older patients
  • Displaced fractures in younger patients and fracture dislocations

Position

  • Beach chair with access for fluoroscopy
  • Beach chair with the arm free

Operative Steps

  1. Deltopectoral approach, retract the cephalic vein laterally
  2. Place traction sutures through the rotator cuff to control the tuberosities
  3. Reduce the head to the shaft, restore neck shaft angle and medial support
  4. Locking plate lateral to the bicipital groove, 5 to 8 mm below the top of the greater tuberosity
  5. Inferomedial calcar screws support the medial column
  6. Check screw tips on fluoroscopy in several rotations to exclude joint penetration
  7. Tie cuff sutures to the plate
  8. Use calcar screws for medial support
  9. Tuberosity sutures through the cuff improve stability

Postoperative Care

  • Sling, early passive motion
  • Active motion once the tuberosities are healing
  • Physiotherapy from early passive motion

Complications

  • Intra-articular screw penetration
  • Varus collapse and screw cut out
  • Avascular necrosis
  • Axillary nerve injury and subacromial impingement
  • Screw cut out into the joint
  • Avascular necrosis of the head

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.