This clinical photograph of a right shoulder shows sutures placed in the rotator cuff before reduction of the humeral head. enlarge

This clinical photograph of a right shoulder shows sutures placed in the rotator cuff before reduction of the humeral head.
Note: the periosteum over the fracture site has already been incised.


This intraoperative x-ray (AP of the proximal humerus) shows the humeral head reduced with a periosteal elevator. enlarge

This intraoperative x-ray (AP of the proximal humerus) shows the humeral head reduced with a periosteal elevator.


The plate is first positioned on the lateral aspect of the humerus after reduction and suture fixation of the tuberosities. enlarge

The plate is first positioned on the lateral aspect of the humerus after reduction and suture fixation of the tuberosities. The insertion guide is somewhat prominent and may catch on the overlying deltoid. Attaching the plate with a single screw ensures that it is properly positioned, after which the insertion guide can be attached.


This illustration shows the properly positioned plate with the insertion guide attached. enlarge

This illustration shows the properly positioned plate with the insertion guide attached.


Guided drilling, through drill sleeve, using the “woodpecker” technique (with alternating advancing and withdrawing the drill). enlarge

Guided drilling, through drill sleeve, using the “woodpecker” technique (with alternating advancing and withdrawing the drill).


Measurement of hole length with a depth gauge. The subchondral bone should be palpable with the gauge. enlarge

Measurement of hole length with a depth gauge. The subchondral bone should be palpable with the gauge.


If in doubt, check the depth gauge placement with the image intensifier. enlarge

If in doubt, check the depth gauge placement with the image intensifier.


Insert a locking-head screw through the screw sleeve. enlarge

Insert a locking-head screw through the screw sleeve.


This shows five locking-head screws placed into the humeral head, and supplementary tension band sutures of the rotator cuff. enlarge

This shows five locking-head screws placed into the humeral head, and supplementary tension band sutures of the rotator cuff with associated fragments.


Final check intraoperative x-rays show the completed osteosynthesis. enlarge

Final check intraoperative x-rays show ...


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... the completed osteosynthesis.


X-rays of the completed osteosynthesis. enlarge

X-rays of the completed osteosynthesis.