Proximal Humerus Fixation

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Proximal Humerus Fractures to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of this procedure is to restore the normal anatomy of the "ball" of the shoulder joint after a proximal humerus fracture. While many proximal humerus fractures can be treated in a sling, displaced fractures often result in severe pain and loss of function due to malalignment. By using a specialized "locking plate," we can hold the broken pieces in their correct position, allowing the bone to heal while permitting early motion to prevent stiffness. This is critical for avoiding long-term complications like osteonecrosis (bone death) or post-traumatic arthritis. However, multiple treatment options for these fractures do exist and depending on the patient’s age and fracture pattern, a reverse shoulder arthroplasty may be a better option.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

The Procedure

  • The Approach: Performed through a deltopectoral incision (front of the shoulder) to allow direct visualization of the fracture fragments while protecting the rotator cuff muscles.

  • Reduction: Dr. Wall carefully pieces the fractured bone fragments back together (reduction), paying special attention to the "tuberosities"—the attachment points for the rotator cuff tendons.

  • Fixation: A low-profile, anatomically contoured locking plate is secured to the outside of the humerus. "Locking screws" thread into the plate itself, creating a fixed-angle construct. This is particularly important for holding fixation in softer, osteoporotic bone.

  • Augmentation: In cases with severe bone loss or poor bone quality, an allograft strut (donor bone) or heavy sutures may be used to reinforce the repair and prevent the screws from pulling out.

Post-Op Protocol

  • Immobilization (Phase 1: 0–4 weeks): Wear a sling at all times when not performing motion or for hygiene purposes. Formal physical therapy begins at Post-Op Week 2 with progressive passive range of motion (PROM). Motion of the elbow, wrist, and hand is encouraged as tolerated. No lifting, pushing, pulling, or weightbearing is permitted.

  • Transition Phase (Weeks 3–4): You will begin weaning from the sling starting at Week 3. By the end of Week 4, you should be completely weaned from the sling.

  • Active Motion (Weeks 4–8): Active-assisted and active range of motion (AAROM/AROM) begins at 6 weeks. At this stage, you may lift light objects weighing 1–2 pounds (roughly the weight of a cup of coffee). Gentle strengthening begins per protocol.

  • Strengthening (Week 8–12): The goal is to achieve full active range of motion. Once achieved, formal shoulder strengthening begins, with lifting capacity increasing to 10 pounds.

  • Full Recovery (Week 12+): Progressive strengthening continues. A return to sports or manual labor is typically cleared once strength is at least 80% of the unaffected side, as confirmed by physical therapy testing.

When to Seek Care

You should schedule a consultation if:

  • You have severe bruising and swelling spreading down your arm and chest wall after a fall.

  • You cannot lift your arm or feel a "grating" sensation in the shoulder with any movement.

  • You have been told you have a fracture at the top of your arm bone (humerus) and want to discuss options for saving your natural joint versus a replacement.