Since the fracture is not exposed, the surgeon should be skilled at closed reduction maneuvers.
Traction applied to the limb helps to realign the proximal fragment as well as the distal.
Threaded pins or K-wires may be inserted into the proximal and distal fragments and used as joy sticks for fracture reduction. However, this technique may be less effective in osteoporotic bone.
The reduction of the humeral head is temporarily secured using 2 to 3 K-wires. The optimal position of the K-wires depends on the fracture morphology.
Confirm the reduction by image intensification in two planes.
Attention should be paid on the correct alignment of the proximal humerus in all planes. Particularly varus malposition has to be corrected. The medial “calcar” region should be well opposed.