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ORIF Proximal Humerus Fracture

intermediate Level

Primary Indication

Displaced 2-4 part proximal humerus fractures in suitable bone quality

Danger Structures

  • undefined - Variable based on approach
  • undefined - Surrounding operative field
  • undefined - Bone surface
  • undefined - Joint surfaces if applicable

Visual Atlas

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Step-by-Step Technique

1

Deltopectoral approach - protect cephalic vein

2

Do NOT release deltoid from clavicle or acromion

3

Identify biceps tendon as landmark for tuberosities

4

Fracture reduction using joysticks, reduction clamps

5

Heavy sutures through tuberosity fragments for manipulation

6

Anatomic reduction critical - restore neck-shaft angle and version

7

Provisional K-wire fixation

8

Locking plate placement - lateral to bicipital groove

9

Proximal locking screws in subchondral bone (support head)

10

Avoid varus reduction (mechanical failure)

11

Medial calcar support screws reduce risk of varus collapse

12

Tuberosity fragment sutures tied through plate holes

13

Check reduction and hardware position fluoroscopically