Disimpaction is the key to successful reduction of these fractures.
After reduction, alignment should be correct in both sagittal and coronal planes. Rotational alignment must also be correct.
Restore normal valgus alignment by reducing the humeral head against the plate. Incarceration of the biceps tendon in the fracture may prevent reduction.
The deltopectoral approach provides safe and good access to the proximal humerus, but it is less satisfactory than the anterolateral approach for the greater tuberosity, especially if displaced posterolaterally.
Correct plate position
A correct plate position must be ensured in order to avoid loss of reduction and impingement.
Angular stable versus standard plates
This procedure describes proximal humeral fracture fixation with an angular stable plate (A). Sometimes, these implants are not available. Standard plates provide an alternative option, for example the modified cloverleaf plate (B). Presently, the specific indications, advantages, and disadvantages of angular stable and standard plates are being clarified. There is some evidence that angular stable plate provide better outcomes. In addition to type and technique of fixation, the quality of reduction, the
soft-tissue handling, and the characteristics of the injury and patient significantly influence the results. There is no evidence that the use of angular stable plates will overcome these other factors.