Overview
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:
Displaced surgical-neck fracture
Significant angulation or displacement affecting shoulder mechanics.
Displaced tuberosity fragments
Rotator cuff pull displaces these fragments away from the bone.
Three- or four-part fractures in active patients
Fixation aims to preserve the native joint.
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 is added as healing allows, with active motion following. Strengthening is delayed until the bone is solidly consolidated. Stiffness and avascular necrosis of the humeral head are the most common complications. Most patients regain functional motion over time.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes a malaligned shoulder with loss of rotator cuff mechanics and a high likelihood of avascular necrosis of the humeral head in severe patterns. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before proximal humerus orif include:
- bleeding and infection
- anesthesia risk
- stiffness
- avascular necrosis of the humeral head
- screw cut-out through the articular surface
- hardware irritation
- axillary nerve irritation
- blood clot (rare in upper-extremity surgery)
The indication to proceed is a displaced proximal humerus fracture in a patient whose bone stock and fracture pattern favor fixation over replacement. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: