We illustrate the use of 3.5 mm cannulated screws. A larger diameter screw may be preferred for larger bone fragments, particularly in the surgical neck region. Since interfragmentary compression is desired, use a lag screw technique, with partially threaded screws inserted so screw threads do not cross the fracture line.
Guide wire insertion
At least two screws should be inserted to fix the fracture. Therefore, insert guide wires at the foreseen cannulated screw positions. Make stab incisions and use blunt dissections to spread the muscles. Check the position of the guide wires by image intensification.
Note: axillary nerve
Beware the axillary nerve and the bicipital tendon.
Cannulated screw insertion
Insert partially threaded cannulated screws of correct length over the guide wires. The screw must not perforate the articular cartilage. Use washers only in osteoporotic bone.
Check of osteosynthesis
Using image intensification, carefully check for correct reduction and fixation (including proper implant position and length) at various arm positions. Ensure that screw tips are not intraarticular.
After confirming reduction and fixation, remove any guide and K-wires. Close wounds as needed.