After preliminary fixation of the reduction confirm the result visually and by image intensification.
There should be no gap and no step-off between the tuberosities. The inferior spike of the greater tuberosity should fit snugly into the fracture gap.
Moreover, one should pay attention to the correct rotational alignment. This can be assessed by the course of the bicipital groove.
The AP x-ray should show the correct relationship between the humeral head and the tuberosities.
Superolaterally, the humeral head and the greater tuberosity should be flush without a step-off or gap. In particular, make sure that the greater tuberosity is not above the humeral head.
Confirm the inclination of the humeral head. The centrum collum diaphyseal angle (CCD) is illustrated. It is the angle between the axis of the humeral diaphysis, and the axis of the humeral neck, best identified as a perpendicular to the base of the humeral head. The CCD should be approximately 135°.
Varus malalignment of the humeral head should be corrected so that the CCD angle is close to 135°. A CCD angle of 120° or less is a predictor of secondary varus collapse, especially when medial support is missing.