Shoulder fracture fixation is performed under a general anaesthetic. Intravenous antibiotics are given to reduce the risk of infection at the time of surgery. Nevertheless, there is still a potential infection risk with all surgery.
Procedure
Most shoulder fractures can be treated through an incision at the front of the shoulder. The interval between the deltoid muscle and the pectoral major muscle is identified and the muscles are gently spread apart. This allows access to the front of the shoulder joint.
The fracture fragments are then identified. Each of the fragments are reduced into position. Temporary pins can be inserted to hold the fragments in place. A plate is then applied to the proximal humerus.
Screws are inserted through the plate into the bone fragments. The screw heads have a locking mechanism which engages into the plate. This prevents any toggling of the screw in the plate and provides a very rigid construct.
Diverging screws are inserted into the head of the humerus which provides stability. The plate is then secured to the shaft of the humerus.
The wound is usually closed with dissolving stitches.
Most patients remain in hospital for at least one night following shoulder fixation surgery.
Post-operative Care
The aim of surgical fixation is to restore the anatomy. If rigid fixation can be achieved, patients may be able to start early range of movement exercises.
Patients are reviewed two weeks following their surgery to check on the wound healing. A follow-up x-ray is arranged six weeks after surgery to look for signs of union at the fracture site.
Recovery following a shoulder fracture can be prolonged. Even with anatomical reduction of the fracture, patients may still have stiffness that lingers for an extended period. Patients will often have a gradual improvement in their range of movement and strength over the first 6 to 12 months following a shoulder injury.