Upper Arm Bone Fractures (Proximal Humerus Fractures): Fixation With a Plate

Upper Arm Bone Fractures (Proximal Humerus Fractures): Fixation With a Plate

This is a surgical demonstration of the repair of an upper arm bone fracture using a plate and screws. When treating an upper arm bone fracture with a plate and screws, the goal is to align the bones and fix them in place so they can heal over the next few weeks to months.

Here we have a right shoulder. The shoulder has been cleaned and an antimicrobial barrier has been applied to the skin giving it the yellow appearance. The surgeon has marked out where they want to make their incision on the front of the shoulder using skin marker.

The incision is made and the surgeon continues to dissect down to expose the bone and fracture location. Once the fracture is identified, the surgeon places pins into the bone to help maneuver and line the bony pieces back up.

The plate is then applied to the side of the arm and held in place with smaller, temporary pins. The surgeon will then check x-ray intraoperatively to ensure the bony pieces are lined up and check the planned location for the appropriately sized metal plate.

To secure the plate to bone, the surgeon will then use screws in the appropriate holes on the plate. When drilling into the upper arm bone, the surgeon will use a depth gauge to determine which length of screw to use. The surgeon will continue to repeat these steps, drill, measure, and place screws.

Once screw placement is complete, the temporary pins are removed from the plate. The surgeon will use intraoperative x-ray 1 more time to confirm the positioning of the hardware. They will look at the ball of the shoulder joint, the humeral head, and verify the screws have not penetrated through the cartilage of the shoulder joint.

Further down on the arm, they will look to see that the tip of the screws have not exited the bone too far. After final x-rays are complete, the surgeon will move on to closing the soft tissue and skin.