Proximal Humerus Fracture Fixation

There are different options of treatment for fracture proximal Humerus,which will be discussed with you and the best option used. The severity of injury, patient and demands will need to be taken into consideration when considering the treatment.

The stabilization of the unstable proximal humerus fracture is commonly done using a plate and screws.Sometimes a rod (nail) may be used. A 12 – 15 cm incision is placed on the side or the front of the shoulder and the fracture is repaired. At the time of surgery sometimes bone graft may be used. This can be taken either from patient or usually I prefer using a donor graft – which is safe and commonly used. Its also traceable.

At the end of surgery the wound is closed with dissolvable sutures and tied over the skin. Butterfly stitches, splash proof dressing and a pad is applied and the arm rested in a sling.

Questions that are often asked

Is the surgery necessary?

This will be discussed with the patient at the time of the consultation..

Before Admission:

No food for 6 hours, or drink for 2 hours, prior to surgery.
Please avoid smoking for 12 hours prior to surgery.
Please continue to take all your medication as advised by the preassessment team.

What happens on the day of surgery?

You will need to report to the main reception on arrival. You will be shown to your room where you will be checked in by the nurse and also see Prof. Singh and the anaesthetist. This will give you chance to ask any questions before surgery. You will also be given an approximate time of your procedure. Please read the instructions on ‘Preparing for Surgery’.

What are the possible complications?

Scar: You will have a 12 – 15 cm incision over the shoulder. This area can be firm to touch & tender for 2 – 3 months. This can be helped by massaging the area with moisturizing cream once the wound has healed.
Infection: Can occur after any operation. This would be treated with antibiotics. This is uncommon following surgery for fracture fixation.
Nerve Damage:It is uncommon to have nerve damage after this surgery, but the axillary nerve may be damaged either by injury or surgery. If this happens can lead to numbness on side of shoulder (regimental badge) and weakness in lifting the arm above head.
Bleeding: Can cause a collection of blood under the stitches which can cause wound problems. Tell the surgeon if you are on anticoagulants or aspirin
CRPS / Stiffness: About 5% (1 in 20) of people are sensitive to surgery and their hand and whole arm may become swollen, painful and stiff after any operation. This problem cannot be predicted but will be watched for afterwards and treated with therapy.
Failure:Sometimes the fixation can fail or the plate fails and then patients can have recurrence of the problem. In worst case scenario may need repeat surgery.

What kind of anaesthesia is used?

A combination of general anesthesia and a nerve block is used for most surgeries. Before the surgery, the anaesthetist will inject numbing medicine around the nerves of the shoulder. This numbs the arm and helps to control your pain after surgery.

How long will I be in the hospital?

Almost all patients are able go home the same day of surgery. Occasionally, patients will be admitted for an overnight stay.

After hospital care:

Sling: After your surgery, you will be fitted with a high arm sling, which is to be used for 2 – 4 weeks after the surgery.
Medication: The nerve block usually lasts between 18 – 24 Patients are encouraged to start taking painkillers before the pain starts i.e. on return home and for at least 48 hours
Wound care &Removal of stitches: At the end of the surgery you have dissolvable sutures to close the skin which are tied over the skin. The sutures will need to be removed at 14 days after surgery which can be performed at your GP practice or nurse at the hospital.
Follow-up orthopaedic clinic: You will need to be reviewed in clinic after your operation. This is usually 2 – 4weeks after surgery.
Physical Therapy A physiotherapist will assess you at the time of your operation and will give you exercises to do before you go home. You will be referred to physiotherapy either in the community or an outpatient department. Rehabilitation typically takes 4 to 6 months and in some cases, may take up to a year.
Return to Work: Managerial or Supervisory: 2– 3 weeks, Light Manual: 4 – 6 weeks (e.g. clerical, secretarial), Heavy Manual: 12 – 16 weeks (ground worker, HGV). This will be guided by the progress of healing and shoulder function. Please discuss with your consultant / therapist if you have any queries.
Drivingyou may be able to drive once the pain is under control and you have movements in the arm – usually around 4 to 6 weeks after surgery. Please let your Motor Insurance Company aware of your procedure.