Open Reduction and Internal Fixation (ORIF) is a surgical procedure commonly employed to address proximal humerus fractures, which typically occur in the upper arm near the shoulder joint. The proximal humerus consists of the head, neck, and greater and lesser tuberosities. These fractures are prevalent in the elderly, especially following falls, but can also occur in younger individuals due to trauma or sports injuries. The aim of ORIF is to restore anatomical alignment and stability to the fracture, facilitating proper healing and the return of function to the shoulder joint. The surgical intervention begins with the patient under general or regional anesthesia, and the specific approach depends on the fracture complexity. An incision is made over the shoulder to access the fractured bone through a technique that minimizes soft tissue damage. The surgeon meticulously realigns the fractured segments of the humerus under direct visualization, ensuring that the architecture of the shoulder is restored. Once the pieces are correctly positioned, internal fixation devices, such as plates, screws, or intramedullary nails, are utilized to secure the fragments together. These devices are critical for providing stability, preventing movement at the fracture site, and allowing for optimal healing conditions. In specific cases, a balloon or spacer may be used if the blood supply to the humeral head is compromised. After securing the fracture, the surgeon will carefully close the incision with sutures or staples, prioritizing aesthetic and functional recovery. The duration of the surgery can vary but typically lasts between one to two hours, depending on the fracture complexity and any additional considerations. Postoperatively, patients are monitored in a recovery area until they are stable enough to be discharged, usually within the same day or after an overnight stay. Following ORIF, a rehabilitation program typically begins, focusing initially on gentle passive range of motion exercises to prevent stiffness while protecting the surgical site. As healing progresses, active exercises are introduced to ensure strength and functionality are regained. The timeline for recovery can vary, with many individuals returning to normal activities within three to six months, though this can extend further based on the individual's health, age, and adherence to rehabilitation protocols. Although ORIF is a prominent treatment for proximal humerus fractures, it carries certain risks, including infection, nerve or blood vessel damage, and complications arising from hardware used in fixation. Long-term results generally highlight good functional recovery, especially when the procedure is performed on younger patients with less complex fractures. Overall, the ORIF surgical procedure for proximal humerus fractures is a vital intervention aimed at restoring mobility and reducing pain, thereby improving the quality of life for those affected by these challenging injuries.
