ORIF Proximal Humerus Fracture

What are Proximal Humerus Fractures?

A proximal humerus fracture is a break in the upper arm bone near the shoulder joint. This type of fracture can severely affect the shoulder joint and immediate medical attention is required in order to preserve shoulder function. A fracture to the humerus bone is a possible consequence of a traumatic event, such as a fall or forceful collision.

What does ORIF mean?

Open reduction and internal fixation (ORIF) is a surgical technique employed for the treatment of fractures to restore the normal anatomy of the bone.ORIF of a proximal humerus fracture involves making a skin incision over the fracture site and attaching a metal plate to the humerus to hold the broken edges of bone in proper alignment, facilitating the healing of the fracture.

Anatomy

The upper arm bone connecting the shoulder and the elbow is called the humerus. The head of the humerus fits into a shallow socket in your scapula (shoulder blade) to form the shoulder joint. Towards the base of the humerus, the bone narrows down and connects to the elbow joint.

Preparation for ORIF of a Proximal Humerus Fracture

ORIF is usually performed to treat severe fractures; it often takes place as an emergency procedure. Preparation for the procedure may involve the following: 

• A physical exam may be performed to look for injury to blood vessels and nerves due to the fracture.
• An X-ray, CT scan, or MRI scan may be ordered to assess surrounding structures and the broken bone.
• If performed as a planned procedure, you will be asked to avoid eating food 6-8 hours before surgery and some of your regular medications may have to be temporarily stopped.

Procedure for ORIF of a Proximal Humerus Fracture

• The surgery is performed under sterile conditions in the operating room under general anesthesia. 
• An incision is made on the side or front of the upper arm to allow access to the humerus.
• Your surgeon will put the fractured ends of your humerus back into position (reduction). 
• A metal plate is inserted and positioned over the humerus, and surgical screws are inserted to attach the metal plate to the bone.
• After securing the bone in place, your surgeon will close the incisions with sutures or staples and cover it with a sterile dressing.

Postoperative Care after ORIF of a Proximal Humerus Fracture

• You will need to keep your arm immobile for several weeks by using a sling to allow for bone healing. 
• Your doctor will instruct you on dressings and incision care and applying ice to relieve pain and discomfort. 
• Physical therapy will be suggested at the appropriate time to prevent shoulder stiffness, strengthen muscles, and restore range of motion. 
• You will also be advised on a healthy diet and supplements high in vitamin D and calcium to promote bone healing. 

Risks and Complications of a Proximal Humerus Fracture

Risks and complications of an ORIF of a proximal humerus fracture include:

• Infection
• Damage to nerves and blood vessels
• Broken screws or plates
• Failure to heal
• Avascular necrosis
• Loss of range of motion