Reduction of the humeral head
Reduction of the humeral head may be possible with digital pressure without open exposure. If this is unsuccessful, one could use a periosteal elevator or a bone hook inserted into the glenohumeral joint through a small incision of the rotator cuff.
Prolonged attempts at closed reduction are not encouraged. Proceed with open reduction through an anterior shoulder arthrotomy. For a description of the anterior shoulder arthrotomy see the deltopectoral approach.
One or two threaded pins in the humeral head may be used as “joy-sticks”, to aid the reduction.
Fix the humeral head temporarily
Secure the reduced humeral head temporarily using 2 or 3 K-wires. As shown, they are placed from distal to proximal.
Make sure that they are anterior enough to avoid interfering with the plate application.
Check the position of the humeral head in the axial/lateral view and be sure that there is no anteversion or excessive retroversion of the humeral head.
Remember that the C-arm should be placed so that AP and axial views can both be obtained by C-arm repositioning without motion of the patient’s arm.