Proximal Humerus Fracture Repair (ORIF)

Who is a candidate?
The proximal humerus is the upper part of the arm bone that forms the ball of the shoulder joint. Fractures in this area can occur after falls, sports injuries, or accidents. Many fractures can be treated without surgery if the bone pieces are well aligned. However, when the bone is broken into multiple pieces, is shifted out of place, or the shoulder is unstable, surgery called open reduction and internal fixation (ORIF) may be recommended to restore alignment and function.

What does the surgery involve?
In an ORIF procedure, the surgeon makes an incision to access the broken bone, then carefully realigns the bone fragments (“open reduction”). Once in the correct position, the pieces are stabilized using a plate and screws, or sometimes pins or wires (“internal fixation”). This holds the bone securely while it heals, allowing the natural bone to knit back together.

How is this different from a shoulder replacement?
ORIF focuses on preserving the patient’s natural bone and joint. It is often recommended for younger, active patients where bone healing potential is good. A shoulder replacement may be considered in older patients with poor bone quality or when the fracture is too severe to be reliably fixed.

What are the potential downsides or risks?
As with any surgery, there are risks of infection, stiffness, or nerve injury. Specific to ORIF, risks include the bone not healing correctly (nonunion or malunion), the metal implants causing irritation, or collapse of the bone if the blood supply is damaged (avascular necrosis). In some cases, additional surgery may be needed if healing problems occur.

What is recovery like?
Recovery takes time and commitment to therapy. The arm may be supported in a sling for the first few weeks. Early on, therapy focuses on gentle motion exercises to prevent stiffness while the bone heals. Strengthening begins later, once the fracture is solid enough. Most patients return to daily activities in a few months, but full recovery can take 6–12 months, depending on the severity of the injury and the individual’s healing process.