Surgery for a proximal humerus fracture can include: suture anchor fixation, plate and screw fixation, intramedullary nail or joint replacement.
Plate and screw fixation is used for most proximal humerus fixations. This is performed through a 12cm incision over the front of your shoulder (fig. opposite - intra-operative x-ray of a specific proximal humerus plate)
Suture repair and the use of bone anchors may be indicated in certain fracture types, generally where only a part of the humerus (greater tuberosity) has been pulled off by the rotator cuff tendons. This is performed through a small (5cm) incision over the side of your shoulder.
Intramedullary nail devices are sometimes used, rather than a plate. This is normally done through a small (3cm) incision over the side of your shoulder. For some patients and fracture patterns this represents the best way of fixing the fracture.
Shoulder replacement is sometimes required to reconstruct a very damaged shoulder, or a complex fracture in a patient with weak bone and poor soft tissue quality. Like many joint replacements, it is generally avoided in patients under 65 years of age. A reverse shoulder prosthesis normally provides more reliable outcomes than a half-shoulder replacement (hemiarthroplasty) in trauma.
Shoulder fracture surgery is performed under general anaesthesia +/- regional nerve block. You will need to stay in overnight after your operation. You will wake up with a sling and your arm may be numb from the nerve block.
Although major complications are rare, proximal humeral fracture surgery can be challenging.
Bleeding – major bleeding is very rare but occasionally you might need a top-up transfusion after surgery
Nerve injury – several nerves pass close to your shoulder and proximal humerus. It is rare for these to get injured during your operation, but if they do get injured, it is normally through stretching, rather than being cut, and they therefore normally recover
Infection – as for all surgery, there is a small chance of infection (approx. 2-3%), which sometimes requires further surgery and antibiotic therapy
Failure of bony healing, or fixation failure - if the bone quality is very poor and the fracture collapses before uniting, or the blood supply has been damaged by the injury, this may be very likely. Non union can affect up to 20% of cases. Sometimes patients require revision surgery. If you've had a replacement, best function relies on healing of the tuberosities (lumps of bone that sere as attachments for your rotator cuff tendons). This is unpredictable in hemiarthroplasty but succeeds in 80% of reverse shoulder replacements after trauma.
Collapse and arthritis of the humeral head. The overall rate of this is about 10%, but certain fracture patterns disrupt the blood supply to the humeral head and make this more likely.
Prominent metalwork – if your fracture collapses down around your screws, they may end up perforating the bone of the humeral head and rub in your shoulder joint. Care is taken during surgery to avoid this, but it can still occur in about 10% of cases and may require implant removal
Please take your painkillers regularly and begin them before your nerve block wears off. You will normally go home the day after your surgery.
You can start to move your shoulder very gently (your physio will guide you as to what you can do and what to avoid)
Please leave your dressing on until your clinic appointment at 2 weeks
Patients vary in their recovery, but you can expect to return to:
Office Work 3-4 weeks (in a sling)
Light manual work 12 weeks
Heavy manual work 18-26 weeks
Driving is allowed once you are confident and competent to control your vehicle for routine and emergency manoeuvres. This usually takes 8-12 weeks.
It can take over 12 months to achieve your full rehabilitation potential after proximal humerus fracture surgery.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
BMI The Princess Margaret Hospital
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Spire Thames Valley hospital
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