Internal fixation techniques for proximal humeral fractures.

Operative treatment of proximal humeral fractures is performed with a variety of fixation techniques. Selection of the optimum device for fixation is dependent on anatomic considerations, fracture characteristics, surgical exposure, and biomechanical features of fixation devices. Fixation objectives are evaluated in light of Neer's four segment classification. An extended deltopectoral approach with release of anterior deltoid distal insertion as well as the proximal pectoralis major raphe provides a wide exposure. The approach heals rapidly and allows rapid rehabilitation. The shoulder fracture fragments are adaptable to tension band wiring. With loss of bone stock, tension band wiring becomes increasingly important because compression or shearing forces can be expended in the tendinous insertion of the fragments. Fixation principles are applied according to specific fracture patterns. Whatever the choice of fixation method, a protracted and vigorous rehabilitation program is essential to achieve maximal functional recovery.