ii) Plate fixation of proximal humeral fractures

Proximalhumeralfracturesaccountforabout5%ofallfractureswithapeak incidence in females aged over 80 and the incidence of these fragility fractures expected to increase. Whilst the majority can be conservatively managed, those with displaced fractures may benefit from surgery. Fractures requiring fixation are a heterogeneous group ranging from simple displaced two part fractures to complex four part fractures and those with disruption of the medial calcar and humeral head blood supply. They require a variety of fixation techniques to achieve anatomical restoration and stability. Locking screw technology permits more stable low profile fixation for these challenging fractures and are now the mainstay of treatment. Whilst these developments aid the surgeon in maintaining stable fixation, successful outcomes continue to rely on the basic principles of initial anatomical reduction and stable fixation with specific attention to the tuberosities to which the powerful rotator cuff muscles attach.