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Proximal Humerus Fracture Operative Fixation

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Evolution of Proximal Humerus Fracture Operative Fixation

Operative fixation of proximal humerus fracture in the non-geriatric, adult patient aims to preserve the natural shoulder articulation, making arthroplasty option less than ideal. The bone fragments must be appropriately realigned either through manipulation or by surgically opening and dissecting down to the fracture site.

Treatment options include closed reduction percutaneous pinning with threaded pins. This technique does not afford the most stable fixation, and pins can migrate either deep and damage cartilage or migrate out of the fracture side resulting in loss of reduction. Some low fracture patterns through the surgical neck of the humerus can be fixed with an intramedullary rod inserted from the top of the humerus and then locked on either end of the fracture site with screws. This procedure violates the rotator cuff and can leave lasting shoulder pain. The advent of locking plate technology heralded in proximal humerus locking plates that aim to preserve the native anatomy and articular surface of the shoulder joint.

After the surgery is complete, patient will often be required to wear a sling and attend physical therapy to regain function at an appropriate pace.

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