Fixation of a Proximal Humerus Fracture Using a Polyaxial Locking Plate and Endosteal Fibular Strut

Proximal humerus fractures have a bimodal distribution and are most commonly seen in the elderly and are the third most common fracture pattern seen in the elderly. There is also a subset of these fractures that occur in younger patients secondary to higher energy mechanisms. Nonoperative management is often advocated for a majority of patients, but surgical fixation is often pursued for younger patients or active, older patients with significantly displaced and reconstructable fractures. The most common options for fixation include open reduction and internal fixation with locking plates and intramedullary nailing. Percutaneous pinning and non-locking plate fixation have lost favor with the advent of improved fixation techniques. Recently developed polyaxial locking plates and the use of endosteal fibular strut grafts offer an excellent option for the fixation of these injuries. In this video, we discuss the case of a 47-year-old man with a four-part proximal humerus fracture.