ORIF is Best Treatment for Proximal Humerus Fractures

Open reduction and internal fixation (ORIF) generally is the best initial treatment of proximal humerus fractures despite a higher reoperation rate with the procedure, an orthopedic surgeon claims.

“Every effort should be made, for every one of these proximal humerus fractures that you decide are unstable and need to be operated on, [to] go in with the thought ‘I am going to try to fix this,’ ” said Anthony A. Romeo, M.D., a professor in the Department of Orthopedics at Rush University Medical Center in Chicago, Ill. Romeo serves as the program director of the Shoulder and Elbow Fellowship, and secton head of Shoulder and Elbow Surgery in Rush’s Sports Medicine division. He also is co-team physician for the Chicago White Sox and Chicago Bulls.

Hemiarthroplasty would be needed if the proximal humerus fracture is in a younger patient and is non-reconstructable, he noted. “If it is an older patient and you just think there is no chance, then we are going to do a reverse [arthroplasty],” Romeo said.

Despite a high reoperation rate with ORIF, results consistently are better in some groups of patients when compared with hemiarthroplasty. The procedure and reverse shoulder arthroplasty are both effective with no significant difference in outcomes or complication rate. Those conclusions do not change significantly with age, either.

“Hemiarthroplasty is really for when you cannot get it fixed well in your hands,” Romeo said.