Open Reduction Internal Fixation of Proximal Humerus Fracture

Open reduction internal fixation, or ORIF, is a surgical procedure used to restore alignment and stabilize selected proximal humerus fractures using plates, screws, and modern fixation techniques designed to preserve shoulder function.

Dr. Streit treats complex shoulder fractures, proximal humerus fractures, and fracture-related shoulder reconstruction with a focus on restoring anatomy, minimizing stiffness, and maximizing long-term shoulder function.

What is a proximal humerus fracture?

A proximal humerus fracture is a break involving the upper portion of the arm bone near the shoulder joint. These fractures vary widely in severity and may involve displacement of the humeral head, greater tuberosity, lesser tuberosity, or shaft.

Some fractures can heal successfully without surgery, while others may require fixation or shoulder replacement depending on:

• Amount of displacement
• Bone quality
• Fracture stability
• Joint involvement
• Rotator cuff integrity
• Patient age and activity level

The goal is not simply fracture healing—it is restoration of a functional shoulder capable of long-term motion and strength.

What happens during surgery?

During ORIF, the fracture fragments are carefully reduced into improved alignment and stabilized using a plate-and-screw construct designed to maintain fixation while healing occurs.

Modern fixation strategies may include:

• Locking plate fixation
• Suture augmentation
• Tuberosity stabilization
• Restoration of humeral head alignment
• Protection of rotator cuff attachments

The objective is to restore shoulder anatomy while preserving blood supply, maximizing fixation stability, and creating an environment favorable for healing.

Technique animation

This surgical animation demonstrates fixation principles for proximal humerus fractures using plate-based fixation and suture augmentation strategies designed to restore alignment, stability, and shoulder function.

Treatment decisions for proximal humerus fractures depend on fracture pattern, displacement, bone quality, rotator cuff integrity, patient activity level, and the likelihood of achieving durable healing and functional recovery.

The objective of surgery is not simply fracture fixation—it is restoration of anatomy, stability, shoulder mechanics, and long-term function while minimizing stiffness and complications.

Recovery after proximal humerus fracture ORIF

Recovery depends on fracture severity, fixation stability, bone quality, rotator cuff involvement, and patient health.

Early rehabilitation focuses on balancing fracture protection with restoration of motion to minimize postoperative stiffness.

• Early sling protection
• Gradual restoration of shoulder motion
• Monitoring fracture healing with imaging
• Progressive strengthening after healing progresses
• Continued improvement over several months

Stiffness is common following shoulder fractures, making rehabilitation strategy extremely important in achieving a functional outcome.

ORIF versus shoulder replacement

Not every proximal humerus fracture is best treated with fixation alone. In some patients, especially with severe comminution, poor bone quality, head-splitting injury, fracture-dislocation, or non-reconstructable anatomy, reverse shoulder replacement may provide a more reliable long-term outcome.

Choosing between fixation and replacement requires careful evaluation of:

• Fracture pattern
• Bone quality
• Tuberosity integrity
• Likelihood of healing
• Risk of avascular necrosis
• Patient goals and activity level

The correct operation is highly individualized.

What this means for patients

Proximal humerus fracture care requires more than simply fixing broken bone. The goal is to restore alignment, shoulder mechanics, motion, strength, and long-term function while minimizing pain and stiffness.

High-quality fracture treatment depends on:

• Accurate surgical decision-making
• Modern fixation strategy
• Protection of shoulder biology
• Thoughtful rehabilitation
• Individualized recovery planning

The best fracture treatment is the one most likely to restore a durable, functional shoulder for the individual patient.