Proximal humerus fracture repair is the surgical fixation of the upper end of the humerus after fracture. The procedure is reserved for displaced fractures, fractures with extensor mechanism disruption, and complex patterns where non-surgical treatment would produce inferior outcomes. Dr. Chudik developed an arthroscopic technique for greater tuberosity fractures that addresses the most common surgical pattern with less soft-tissue disruption than open surgery.
What Is Proximal Humerus Fracture Repair?
The proximal humerus has four anatomic parts: the humeral head, greater tuberosity, lesser tuberosity, and shaft. Fractures are classified by the number of displaced parts (Neer classification). Surgical treatment depends on the pattern:
- Greater tuberosity avulsion fractures: often associated with shoulder dislocation. Dr. Chudik developed an Arthroscopic Proximal Humerus Greater Tuberosity Fracture Repair technique that addresses these fractures through small incisions where conventional treatment requires open surgery.
- Two-part surgical neck fractures: often treated with intramedullary nailing or plate fixation
- Three-part fractures: typically treated with open reduction and internal fixation using a locking plate
- Four-part fractures: high risk of avascular necrosis. Treatment options include locked plate fixation, hemiarthroplasty, or reverse total shoulder arthroplasty in older patients
Who Is a Candidate?
Surgical treatment is indicated for:
- Displaced fractures with significant separation of fragments
- Greater tuberosity displacement that affects rotator cuff function
- Three- and four-part fracture patterns
- Fractures associated with shoulder dislocation
- Open fractures
- Fractures with neurovascular compromise
Approximately 80 percent of proximal humerus fractures are minimally displaced and treated non-surgically with sling immobilization and early motion.
How the Procedure Is Performed
For arthroscopic greater tuberosity repair (Dr. Chudik’s developed technique), the procedure is performed through standard arthroscopic portals. The displaced tuberosity is mobilized, reduced anatomically to the humeral head, and fixed with suture anchors that secure the rotator cuff attachments along with the bone. The arthroscopic approach avoids the deltoid splitting and open exposure of conventional treatment.
For open reduction and internal fixation of three- and four-part fractures, a deltopectoral incision exposes the proximal humerus. The fracture is reduced under direct visualization and fixed with a locking plate. The plate is contoured to the proximal humerus shape, with calcar support screws to prevent collapse in osteoporotic bone.
For comminuted four-part fractures in older patients with poor bone quality, reverse total shoulder arthroplasty is often the preferred treatment.
Recovery and Rehabilitation
Recovery depends on the procedure and bone quality:
- After arthroscopic greater tuberosity repair: sling for four to six weeks, passive motion within days, active motion at six weeks, strengthening at three months
- After open plate fixation: sling for four to six weeks, similar progressive motion timeline, return to most activity at three to four months
- After reverse arthroplasty: sling for two to four weeks, faster return to active motion than after fixation
- Return to sport ranges from four to nine months depending on procedure and bone healing
Risks and Outcomes
Risks include avascular necrosis of the humeral head (especially in four-part patterns), nonunion, malunion, hardware failure, infection, and stiffness. Outcomes depend heavily on bone quality, fracture displacement, and rehabilitation adherence.
Why Dr. Chudik for Proximal Humerus Fracture Repair
Dr. Chudik developed Arthroscopic Proximal Humerus Greater Tuberosity Fracture Repair, which addresses the most common displaced fracture pattern through small arthroscopic incisions rather than open surgery. For complex patterns, he treats the full range of fracture surgery, including locked plate fixation, hemiarthroplasty, and reverse total shoulder arthroplasty, with the choice driven by patient age, bone quality, and fracture pattern.